Clinic germs are so dangerous
Clinic germs are so dangerous
Germ free hospital room, sterile instruments and clean hands: Those being treated in hospital normally expect high hygiene standards. Nevertheless hundreds of thousands of patients become infected with dangerous germs in hospitals each year. Thousands die as a result, an example in August 2011 three new born babies in a hospital in Bremen. Bacteria, which are virtually resistant against antibiotics are increasingly becoming a problem in hospitals, doctors surgeries and old peoples homes. We answer the most important questions on this subject:
Which pathogens are they?
In most cases it is the MRSA ( Methillicin-resistent Staphylococcus aureus) bacteria. The bacteria strain can cause serious or deadly disease and is resistant against most antibiotics including penicillin. So-called Vancomycin-resistant Enterococci (VRE) can activate dangerous intestinal illnesses. Behind an ESBL-infection, which was also responsible for the death of the babies in Bremen, are resistant Enterobacteria which belong to the normal human intestinal flora, but which pose a danger for ill or weak people.
How many people become infected?
There are no precise figures for frequency of infections in hospitals in Germany. It is estimated that each year between 400.000 and 1 million people become infected during a hospital stay. Conservative estimates assume between 7500 and 15.000 deaths. Whereas the Deutsche Gesellschaft für Krankenhaushygiene (DGKH) counts the annual number of deaths due to hospital infections up to 40.000.
What makes the germs so dangerous?
For healthy people MRSA is not usually dangerous. For patients with weakened immune systems in the intensive ward, patients with cancer, operation-patients or people with chronic wounds, these multi resistant pathogens can be dangerous and cause pneumonia, wound and urinary infections or blood poisoning. Resistant pathogens have become insensitive to various antibiotics, which clearly restricts the therapy possibilities. Also, it can often take days before the pathogen is even identified.
How does an antibiotic resistance occur?
The resistance of bacteria is evident when the antibiotics are removed from the cell by specific transport systems before it can take effect or it is eliminated with the help of enzymes. The resistance can be quickly passed on from one bacteria to another bacteria.
Can MRSA nevertheless be treated?
Basically yes, although MRSA is resistant to most antibiotics, there are the so-called reserve antibiotics, which are normally only given in hospitals.
How are the multi resistant pathogens transmitted?
The transmission takes place mostly through direct contact, which is why the disinfection of the hands is most important in the fight against the germs. Apart from strict hygiene, experts demand a moderate use of antibiotics to prevent resistance. Infections in hospitals benefit from the fact that more often patients with complicated progression of their illness are being treated.
Tens of thousands die of clinic germs „an ever increasing risk“
Every year in this country – according to figures of the Deutschen Gesellschaft for Krankenhaushygiene (DGKH) – approximately 800.000 people become infected by hospital germs, 40.000 of those die as a result. It is not surprising that pathogens are present in hospitals with which man would never come into contact at home. Patients and visitors bring the germs with them, they often live healthily with them. It becomes dangerous when the germs come into contact with wounds or catheters and are thereby transmitted to weakened patients. This subject is not new but, in the last few years, seems to have reached a new dimension. There are many questions. Dr. med. Klaus-Dieter Zastrow, doctor for hygiene and environmental medicine and speaker for the DGKH gives answers to the most important of those in an interview on n-tv.de:
Dr. Zastrow, what makes hospital germs so dangerous?
Klaus-Dieter Zastrow: The germs are normally not dangerous. When, however, they get into wounds, lungs, bladder or blood circulation, they cause infections, which can progress dramatically –from the simple wound infection right up to sepsis, followed by death. The problem is that the so-called hospital germs are multi resistant pathogens. This means that more and more antibiotics are increasingly ineffective against these germs. Therefore they are becoming an increasing danger for hospitals.
Why does one hear more about hospital germs in recent years, much more often than before?
Multi resistant germs have always existed, but in recent years, several pathogens are increasingly apparent. This is because the problem was not treated seriously and doctors have prescribed antibiotics unspecifically. Often, some type of antibiotic has been used, but not the specific one which is best suited to deal with the bacteria in the specific illness. Or antibiotics have been prescribed when it is not even clear that a bacterial infection is the diagnosis. A targeted usage of antibiotics would restrict the growing resistance of the germs. Also the cost pressure and time pressure in the hospitals, the inadequate hand disinfection and insufficient training of doctors and health workers are all factors which assist the transmission of germs. In the six year studies, a doctor has only 10 or 20 teaching hours about hygiene.
In the Netherlands, the problem with hospital germs is less widely distributed than in Germany. Why is this?
In the Netherlands the hygiene measures don’t just exist on paper. There, risk patients and also the medical personnel are preventatively, thoroughly examined for dangerous germs. Additionally, doctors in the Netherlands are not permitted to prescribe antibiotics without an appropriate examination and diagnosis.
Is it true that the hygiene rules are not practicable in the daily clinic routine?
That is rubbish. Contrary to the general opinion of hospital directors, hygiene is not expensive. It becomes expensive when an infection arises through a lack of hygiene. This often leads to an extended hospital stay with expensive therapeutical measures. Without the infection, these measures would not have been necessary.
The Universitätsklinikum Münster is regarded as a model hospital with regard to infection prevention. What is different there to other hospitals in Germany?
They resolutely follow the safety measures as published by the Robert-Koch-Institut as long ago as 1999 against MRSA, one of the most frequent hospital germs.
What does an effective infection protection in a hospital look like?
„The most important protection is the consistent compliance and control of the existing hygiene rules. A commission at the Robert-Koch-Institut has prepared numerous recommendations for hospital hygiene. Also, risk patients could be examined using a quick test for multi resistant germs when they check-in. A populated or infected patient could then be strictly isolated. In clinics there should be a full-time medical doctor specialist for hygiene as well as hygiene specialists, who monitor the compliance with the measures and give training courses.
Particularly threatening are hospital germs in the premature infants ward The immune system of the premature babies is not matured. Is it possible to fully eliminate infections for premature births? Or would a one hundred percent protection also be possible through particular measures?
By strictly following the hygiene measures, infections can also be prevented in the premature baby ward.
Is every infection in hospitals avoidable?
By particular operations, for example on the bowel where billions of germs exist, even with sufficient preparation (colonic irrigation etc.) an infection is still possible. This risk is calculable so a therapy can immediately be initiated. With operations or surgical intervention on joints, a knee arthroscopy or a replacement artificial hip joint, an infection can always be traced back to inadequate hygiene. These are avoidable infections.
How can hospital germs be tackled in the future? Where must hospitals improve?
As a result of the educational work of the DGKH, the government has become aware of the problem. The infection protection law was revised in August 2011 and the hygiene for hospitals and other medical institutions defined by law. Clinics must clearly improve their hygiene and the hygiene standards must be consistently implemented. Therefor it is necessary that a hygiene awareness exists for doctors and nursing staff and the scientifically developed measures are integrated into the work schedules of the medical staff. In every hospital there must be an adequate number of specialist hygiene staff available. Only then is it possible with specialist instruction and control to ensure that the standards are learned and adhered to.
Can patients do something themselves against infection with the potentially dangerous germs?
If a stay in hospital or an invasive procedure is planned, the patient should previously inform themselves if the hospital has a department for hygiene or specialist hygiene personnel. The patient, health permitting, can also make sure that the doctors and nursing staff always disinfect their hands before a treatment. However, the patient is the weakest link in the chain. No one can seriously expect that the patient themselves can contribute to the prevention of a hospital infection. The patient comes to the hospital ill, with pain or seriously injured and unconscious. In this condition he is in no condition to control the doctors and nursing staff?
That is a bad joke! The patient does not just have the right to have well trained personnel but also of hygienically impeccable treatment.
Hospital germs ...
... are multi resistant germs. This means that against an infection with such pathogens, several antibiotics have little or no effect.
MRSA: is not the most dangerous, but the most common hospital germ. It causes approx. 30 percent of all hospital infections. Up to 2000 patients die each year. Behind the initials are bacteria of the type Staphylococcus aureus, which have become resistant against antibiotics like Methicillin. That is in Germany around 20 percent of the Staphylococcus aureus, in the Netherlands it is less than 1 percent. MRSA exist in three groups auf:- with animals in herds and stables. From the animals they can be transmitted to humans as an aggressive variation which can also cause illness to healthy people (only about 2 percent of all MRSA in Germany belong to this type) – the hospital -MRSA. They are predominant in Germany. The bacteria live in the nose and throat region of patients. The patient brings them into the clinic. They are then further transmitted e.g by sneezing.
The bacteria can cause abscesses, urine and respiratory infections or also blood poisoning.
Pseudomonas aeruginosa: causes around 10 percent of all hospital infections in Germany. Can cause pneumonia, urine infection, meningitis or endocarditis.
Escherichia coli / Klebsiellen: belong to the ESBL-creators, this means they can create enzymes, which can destroy most antibiotics including penicillin. Many people have them as infections pathogens already in their bowel. They can be transmitted when in contact with pathogen-containing secretion (faeces, wounds). Several E. coli-strains can cause severe bowel illnesses and cause kidney damage. Klebsiella pneumoniae can cause urine and respiratory infections. ESBL-creators are on the increase
Enterococci: are bowel bacteria, with which also healthy people live. They can be transmitted from skin to skin, by hands or by contaminated objects. Some strains can lead to urine infection or endocarditis.
Staphylococcus epidermidis: populate the human skin and mucous membranes, can also be found in foods and is hardly a risk for healthy people. People with weakened immune systems it can lead to heart disease or pronounced wound infection. 70 percent of the Staphylococcus epidermidis-strains are resistant to Penicillin and Methicillin.