[Hygiene in ophthalmological practices : Results from ophthalmological practices in Frankfurt am Main in 2012-2015]. / Hygiene in der Augenarztpraxis : Ergebnisse aus den Augenarztpraxen in Frankfurt am Main, 2012­2015.

BACKGROUND: Hygiene regulations must be taken into consideration for all diagnostic and therapeutic measures in order to avoid transfer of pathogens and infections. The Infection Protection Act assigns the responsibility for prevention of infections to managers of medical institutions, i.e. the owners of a practice and public health authorities are obligated to counsel and monitor medical institutions with respect to hygiene and prevention of infections. This article presents the results of the surveillance of all ophthalmological practices in Frankfurt am Main in 2012-2015, which are assessed and discussed against the background of the valid recommendations of the Committee for Hospital Hygiene (KRINKO). METHODS: Based on a checklist, all 35 ophthalmological practices in Frankfurt am Main received counseling and were monitored by an official from the Public Health Office. RESULTS: The basic principles of hygiene organization as well as the prerequisites for appropriate hand hygiene and surface disinfection were present in the majority of practices. In 11 practices (31.4 %) disposable medical products were exclusively utilized but medical products were prepared in-house in 24 practices (68.6 %). Contact pads for tonometry were prepared in-house in 13 (37.1 %) practices of which 6 were deficient so that improvements had to be implemented. In 6 out of the 7 practices where even critical medical products were prepared, this preparation was prohibited due to significant errors and the practices had to switch to disposable materials. DISCUSSION: In total, the practices could be certified as having a good general level of hygiene; however, in some cases major errors were found in the preparation of medical products, which had to be immediately corrected.

Re-thinking risk communication: information needs of patients, health professionals and the public regarding MRSA--the communicative behaviour of a public health network in Germany responding to the demand for information.

OBJECTIVES: Multidrug resistant organisms (MDRO), including Meticillin-resistant Staphylococcus aureus (MRSA), and health care associated infections (HCAIs) are pressing issues for health care systems across the world. Information and communication are considered key tools for the prevention and management of infectious diseases. Public Health Authorities (PHA) are in a unique position to communicate with health care professionals, patients and the public regarding the health risks. STUDY DESIGN: We used PHA helpdesk interaction data to first ascertain the information requirements of those getting in contact with the service, and secondly to examine the communicative behaviour of the PHA, with a view to improving the quality of communication strategies. METHODS: Data on helpdesk interactions between 2010 and 2012 were obtained from a MDRO network of nine German PHAs. 501 recordings were coded and descriptive statistics generated for further qualitative thematic analysis. RESULTS: Our analysis revealed a similar pattern of questions among different groups. Key areas of need for information were around eradication, cleaning and isolation measures. Reported problems were a lack of expert knowledge and continuity of treatment. The helpdesk response was mainly a conversation offering scientific advice, but also included other communication services that went beyond the provision of scientific facts, such as follow-up calls, referral suggestions and consultations on behalf of the caller. These social communication activities seem to have an important impact on the acceptability of public health recommendations and use of the helpdesk. CONCLUSIONS: Our findings support a broader discussion about the role of information in the communication process and underline the importance of social elements in the communication process, such as relationship and trust building.

[Surface Cleaning and Disinfection in the Hospital. Improvement by Objective Monitoring and Intervention]. / Flächenreinigung und Desinfektion im Krankenhaus. Verbesserung durch objektive Überwachung und Intervention.

Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11-67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2-48.3; p<0.05), with differences between the hospitals (20-95%). The largest increase was achieved in hospital wards (+45%; CI 29.2-60.8; p<0.05). Improvements in operating theatres (+22.9%; CI 10.9-56.7) and intensive care units (+5.6%; CI 25.8-36.9) were statistically not significant. Conclusions: The monitoring of cleaning and disinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures.

[Multidrug-Resistant Organisms (MDRO) in Rehabilitation Clinics in the Rhine-Main District, Germany, 2014: Risk Analysis and Hygiene Procedures]. / Multiresistente Erreger in Rehabilitationseinrichtungen im Rhein-Main-Gebiet, Deutschland, 2014: II. Ärztliche Risikoanalyse und Hygienemaßnahmen.

BACKGROUND: Many regional German MDRO-networks aim to improve the medical rehabilitation of patients with methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant pathogens. In 2014, the German Commission for Hospital Hygiene and Infection Control (KRINKO) released revised recommendations for the care of patients with MRSA. In particular, for rehabilitation facilities, these recommendations stipulated a medical risk analysis to establish necessary hygiene measures, and provide specific recommendations. MATERIAL AND METHODS: Based on a large investigation carried out in 21 rehabilitation facilities covering different medical specialties, medical risk analyses according to KRINKO were performed, and the findings evaluated separately for orthopedic, cardiologic, oncologic, neurologic, or geriatric facilities, as well as for all institutions taken together. RESULTS: The overall colonization pressure, i. e. the point prevalence of MRSA and extended spectrum beta-lactamase-producing gram-negative pathogens (ESBL) among hospitalized rehabilitation patients was found to be 0.7% and 7.7%, respectively. Impairment of the intact skin (an established risk factor for persisting MRSA colonization and MRSA infection) was found in 7% of the patients, impaired mobility requiring enhanced level of care in 4.1%, and mental confusion and/or incontinence (potentially impairing the application of hygiene measures) in 11% of patients. Compared to the total study population, there was an increase in all risk factors in geriatric and neurologic rehabilitation patients: skin barrier breaches (in neurologic and in geriatric patients: 18.3 and 19.2%, respectively), impaired mobility (32.7 and 37.0%, respectively), and mental confusion/incontinence (24.5 and 28.0%, respectively). In addition, geriatric patients demonstrated an increased overall prevalence of multidrug-resistant organisms (MRSA: 9.4%; ESBL: 22.7%). DISCUSSION: Risk analysis according to KRINKO showed that in rehabilitation facilities with internal medicine or orthopedics specialties, there was a comparably lower risk for transmission, colonization, and/or infection with multidrug-resistant pathogens, as against institutions with neurologic or geriatric specialty. It appears that in the first type of rehabilitation facilities, consistently carried out basic hygiene measures are sufficient while in neurologic or geriatric rehabilitation hospitals, these measures should be supplemented with additional hygiene measures based on medical risk analysis. Furthermore, for infection control purposes in rehabilitation facilities, patient isolation will be rarely necessary or appropriate. These analyses suggest that in the future, rehabilitation programs for MRSA/ESBL-colonized patients will be more successful.

[Hygiene in otorhinolaryngology: Requirements and reality]. / Hygiene in der Hals-Nasen-Ohren-Heilkunde: Anforderungen und Beobachtungen.

Considering the physiological contamination of skin and mucous membranes in the ear, nose, and throat region by facultative pathogen microorganisms, as well as the increase in multidrug resistant organisms (MDRO), it is mandatory that hygienic procedures be observed in ENT institutions, in order to prevent transmission of bacteria and infections in patients. General guidelines for hygiene in otorhinolaryngology are presented based on the recommendations published by the German Commission on Hospital Hygiene and Infection Prevention (KRINKO). These encompass hand hygiene, surface disinfection, and reprocessing of medical devices. The correct reprocessing of the various components of ENT treatment units (including endoscopes, water bearing systems) is reported. Although law requires and KRINKO recommends that manufacturers of medical devices publish instructions for reprocessing their products, these reprocessing recommendations are often insufficient. Manufacturers should thus be called upon to improve their recommendations. In this paper, the requirements for handling of ENT treatment units are compared with the observations made by the Public Health Department in 7 ENT clinics and 32 ENT practices in Frankfurt/Main, Germany, in 2014.

[Multidrug-Resistant Organisms (MDRO) in Rehabilitation Clinics in the Rhine-Main-District, Germany, 2014: Prevalence and Risk Factors]. / Multiresistente Erreger in Rehabilitationseinrichtungen im Rhein-Main-Gebiet, Deutschland, 2014: I. Prävalenz und Risikofaktoren.

BACKGROUND: While a limited number of studies have investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in medical rehabilitation institutions, almost no data on the colonization of rehabilitation patients with multiresistant gram-negative rods is available. Here we report on a large multicenter study on the prevalence of MRSA and multiresistant pathogens in rehabilitation institutions in the Rhine-Main area in 2014. MATERIALS AND METHODS: Altogether, 21 rehabilitation hospitals participated. For all patients, age, gender, previous history of hospitalizations, surgery, previous colonization with multidrug-resistant organisms, use of a medical device, current antimicrobial therapy, and the current infection status were ascertained. On voluntary basis, nare and throat swabs were taken for analysis of MRSA and rectal swabs were tested for extended spectrum betalactamase-producing gram-negative bacteria (ESBL). RESULTS: 50% of 2 440 patients had a history of hospitalization within the previous 6 months while 39% had undergone surgery during the past 30 days. Approximately a quarter of the patients had been transferred to a rehabilitation hospital directly from an acute care hospital, had been under antimicrobial therapy with the past three months, or had travelled to a foreign country within the previous year. Risk factors such as lesions of the intact skin or presence of medical devices were rarely reported (< 5%) within the exception of patients undergoing geriatric or neurologic acute care rehabilitation. 0.7% (15/2155) of the patients were colonized with MRSA, while 7.7% (110/1434) showed a positive result for ESBL. The highest prevalence rates for multiresistant organisms were encountered among patients with neurologic rehabilitation (MRSA, 1.3%, and ESBL, 10.2%) or with geriatric rehabilitation (MRSA, 9.4%, and ESBL, 22.7%). CONCLUSION: In the rehabilitation patient population, the prevalence rates of MRSA and ESBL were found to be in the range of rates encountered in the general population (reported rates for MRSA, 0.5%, and ESBL, 6.3%). The known risk factors for MRSA such as skin lesions, medical devices and previous history for MRSA were also confirmed among this patient population. Direct transfer from an acute care hospital, antimicrobial treatment during the past 3 months, and wounds proved significant risk factors for ESBL colonization. Patients of neurologic rehabilitation and geriatric patients showed the highest rates of risk factors and the highest prevalence rates of multidrug-resistant organisms. It appears to be of importance for rehabilitation hospitals to be geared to the needs of patients with multidrug-resistant organisms, and prevent the transmission of these pathogens by appropriate hygiene measures.

[The Humanitarian Consultation-hour in Frankfurt am Main: Utilization by Gender, Age, Country of Origin]. / Die Humanitäre Sprechstunde in Frankfurt am Main: Inanspruchnahme nach Geschlecht, Alter und Herkunftsland.

BACKGROUND: The humanitarian consultation-hour is a voluntary, anonymous offer provided by the City of Frankfurt am Main, which was established in December 2001. Here, people without health insurance or undocumented migrants can be treated for free. The aim of this analysis is to investigate the utilization of the consultation-hour by gender, age, country of origin and diagnosis since 2008. METHODS: The digital data documentation is available since 2008. Data from the years 2008-2013 were considered. The examination date, the date of birth, sex, country of origin, frequency of visits, diseases and medication amongst other data were examined. RESULTS: In the period from 2008 to 2013, 8,574 consultations were counted and 2,384 patients were treated during office hours. The amount of consultations has doubled between 2008 (n=673) and 2009 (n=1,154) and is rising steadily since then (1,911 visits in 2013). The majority of patients come from Africa. Since 2008, an increase of patients from Bulgaria and Romania has been recorded. Approximately two-thirds of the patients are female, one third male. One fifth of those seeking help are children and adolescents under 20 years and adults over 60 years. The most common age group is between 20-40 years old. The main diagnoses include diseases of the cardiovascular and vascular system and the musculoskeletal system, metabolic diseases (diabetes mellitus), digestive diseases and pregnancy/childbirth. CONCLUSION: The humanitarian consultation-hour is an important offer provided by the Public Health Department of the City of Frankfurt am Main and is used by a large number of people who are seeking help. In particular, people from South Eastern Europe are increasingly visiting the consultation-hour. Activities such as the humanitarian consultation-hour can take over subsidiary activities for a transitional period, however long-term structural solutions must be provided to ensure access to health care for this vulnerable group.

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013.

Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.

[Hygiene and Infection Prevention in Medical Institutions, Kindergartens and Schools - Statutory Basis, Infection Control Practice and Experiences of the Public Health Services]. / Hygiene und Infektionsprävention in medizinischen Einrichtungen und in Kindergemeinschaftseinrichtungen - Gesetzliche Grundlagen, Überwachungspraxis und Erfahrungen der Gesundheitsämter.

Infection prevention is one of the main tasks of the public health services. The "Protection against infection act" places all medical institutions and facilities for children (kindergartens and schools) under the obligation to assume responsibility and to cooperate. Duties of the institutions are described, and public health services are obliged to perform hygiene control visits.Regarding medical institutions, the guidelines of the German Commission on Hospital Hygiene and Infection Control have to be observed, and the counties were obliged to publish hygiene enactments. Subsequently, good improvements in hygiene management in medical institutions were achieved. In schools, however, severe hygienic problems (i.e. sanitary hygiene, indoor air hygiene) are detected, without any improvement - obviously due to a missing sense of responsibility in the school community. Causes for poor behaviour prevention (hand hygiene, ventilation) and missing situational prevention (i.e. cleaning) are discussed. Without reversion to the obviously needed but nearly forgotten subject school hygiene, obligatory guidelines and the assuming of responsibility, permanent improvements cannot be achieved.

[Amendments to the Drinking Water Ordinance: Legionellae in Hot Water Systems - Data from the Public Health Authority Frankfurt am Main, Germany]. / Änderungen der Trinkwasserverordnung: Legionellen in Großanlagen - Erfahrungen aus dem Gesundheitsamt Frankfurt am Main.

BACKGROUND: The first and second amendment to the Drinking Water Ordinance came in to force in the years 2011 and 2012 causing additional tasks and responsibilities for operators of commercial large-scale systems, usually hot water systems in large residential buildings, and for the local health authorities. This article describes the experiences of the health authority in Frankfurt/Main with these new regulations. Some of the revisions in the first amendment of the ordinance (TrinkwV 2001 (2011)) were omitted in the second revision (TrinkwV 2001 (2012)) such as the obligation to notify for large-scale systems. Furthermore, the intervals between the obligatory inspections were extended from 1 to 3 years and merely exceedances of the legal limits were to be notified in contrast to the previous obligation to notify all values. RESULTS: On the basis of the TrinkwV 2001 (2011) a large additional staff requirement had been estimated (13/21 positions). After the TrinkwV 2001 (2012) the tasks can be accomplished by less than 2 employees. While the notification obligation was still in force, the health authority received 4,461 notifications of large-scale systems, since then a further 477 have been notified. Of a total of 1,335 initial analyses, 794 (60%) exceeded the technical action value and in 113 properties with values exceeding 10,000/100 ml a usage restriction was necessary. CONCLUSIONS: Due to the suspension of the notification obligation to report any result of the analyses performed the assessment of the reports on large-scale systems has become difficult. An appropriate assessment of the implementation of the regulation is not possible, since the total number of large-scale systems is not known and a failure to report may result from a measured value below the technical action value as well as from a not inspected system. The large number of usage restrictions is an indication for the necessity to inspect and if required to treat and restore the system.

[Hygiene in endoscopy in clinic and practice 2013 in comparison with 2003--structure and process quality]. / Struktur- und Prozessqualität bei der Aufbereitung flexibler Endoskope in Klinik und Praxis in Frankfurt am Main--2013 im Vergleich zu 2003.

BACKGROUND: Endoscopy is an important part of modern medical diagnostics and therapy. The invasive procedures are however associated with a risk to transmit infections. Against this background the KRINKO has published the "Hygienic requirements for the reprocessing of flexible endoscopes and endoscopic accessories" in 2002 and has updated these recommendations in 2012. In 2003 and 2013 all gastroenterological facilities in Frankfurt am Main using flexible endoscopes were monitored for compliance with the recommendations. METHODS: The inspections were performed after prior notice by a staff member of the health authority using a checklist which had been developed on the basis of the current KRINKO recommendations. RESULTS: In both years all institutions performing endoscopic procedures were visited: 2003 15 hospitals and 23 practices; 2013 14 clinics and 10 practices. In 2013 (data for 2003 in brackets) 100 % (93 %) of the hospitals and 60 % (22 %) of practices reprocessed their endoscopes by automated methods. The appropriate reprocessing and filling of water bottles for rinsing the scope channels with sterile water and the sterilisation of accessories were satisfactorily performed in 2003 and 2013 by all hospitals. However in 2013 only 90 % (2003: 74 %) of the practices correctly reprocessed water bottles and 80 % (52 %) used sterile water for filling the bottle. In 2013 100 % (2003: 57 %) of the practices correctly sterilised accessory instruments, while 2 practices used disposable, i. e., single-use materials. In 2013 all institutions performed microbiological tests according to KRINKO recommendations, while in 2003 all hospitals but only 43 % of the practices could present such tests. DISCUSSION: While the gastroenterological departments of Frankfurt hospitals already complied with the KRINKO recommendations in 2003, the inspection of several practices in 2003 had revealed considerable shortcomings in the implementation of these recommendations. Subsequently the practices have improved their hygiene management.

Heat waves and mortality in Frankfurt am Main, Germany, 2003-2013: what effect do heat-health action plans and the heat warning system have?

UNLABELLED: Following the heat wave of August 2003 that caused over 70,000 fatalities in Western Europe, heat-health action plans (HHAP) and heat warning systems were implemented in many European countries, including Germany. The effect of these preventive measures (informing the population as well as nursing and medical personnel) on excess mortality during heat waves in Frankfurt am Main, Germany, is studied, taking into account newly published data on a modifying effect of air pollution on heat mortality. MATERIAL AND METHOD: Mortality data comprising all deaths registered in the city of Frankfurt was obtained from the statistical state office; air temperature and air pollution data in Frankfurt Ost were obtained from the Hessian state office for environment and geology. SPSS Version 15 was used for statistical analysis (bivariate and partial correlations, nonparametric tests/Kruskal-Wallis, and Mann-Whitney test). RESULTS: Temperature data as well as air pollution and daily mortality exhibited extreme values in summer 2003 compared to the summer periods 2004-2013. Never again were such levels of temperature and air pollution reached. In 2003, excess mortality was 78%, and as high as 113% among the population aged >80 years. During the heat wave of 2010, the total excess mortality was 23% (significant) and 38% in the population aged >80 years, while during heat waves in 2006 and 2013 no significant increase in total mortality was seen (total excess mortality 12% and 4%; not significant). CONCLUSION: Lower excess mortality could be seen in Frankfurt am Main during heat waves following the implementation of HHAP and the heat warning system. This might be an effect of the measures implemented by the HHAP to reduce heat mortality. However, it cannot be ruled out that this might also be an effect of shorter heat wave periods and lower air pollution in the subsequent years. Therefore, further efforts are needed to improve the resilience of the population, especially the elderly population, to better cope with heat waves.

[Network against multidrug-resistant organisms in the Rhine-Main region, Germany. A first evaluation]. / MRE-Netz Rhein-Main - Wie bewerten die Einrichtungen die Angebote des Netzwerks? - Eine erste Zwischenevaluation.

BACKGROUND: Multidrug-resistant organisms (MDROs) are not only a problem in the hospital but also in the community setting. The MRE-Net Rhine-Main was founded in order to decrease the rate of development and spread of MDROs in the region and to counter the stigmatisation of people with MDROs. The network attempts to achieve these goals by offering telephone support, information flyers, internet services, information events and training for health-care practitioners from hospitals (HOSP), residential and nursing homes (RNH), outpatient care services (OCS), emergency services (ES), medical practices (MP) and rehabilitation centers (RC). A first interim evaluation examined the expectations each institution had associated with its participation and how well these objectives were fulfilled. Furthermore the utilisation and acceptance of the services offered by the network were investigated. METHOD: The participating institutions (n=143) received a standardised questionnaire adapted to the type of institution by mail including questions focusing on the above-mentioned issues. RESULTS: 96 questionnaires could be evaluated (response 67.1%). More than 90% of the participants expected to participate in trainings, receive improved information, to gain more confidence in handling patients and to improve hygiene measures - with great differences between HOSP, RNH and OCS. These expectations were largely satisfied. 65.5% of the institutions participated at least once in a training, particularly RNH, OCS, whereby the usefulness of the trainings was rated high by these institutions. 14.4% of the institutions had made use of the telephone service, the gain of information was rated as high by HOSP, RNH and OCS. 81% knew of and used the flyers, but almost half of the institutions did not know the homepage of the network. CONCLUSIONS: Overall the expectations of the network participants were met well to very well and the benefit derived from the trainings and the print and online media was rated as high. Therefore the network will continue and further intensify its work.

[Healthcare associated infections (HAI), antibiotic use and prevalence of multidrug-resistant bacteria (MDRO) in residents of long-term care facilities: the Frankfurt HALT plus MDRO project 2012]. / Nosokomiale Infektionen, systemischer Antibiotikaeinsatz und multiresistente Erreger bei Bewohnern von Altenpflegeheimen : Das Frankfurter HALT plus MRE-Projekt, 2012.

BACKGROUND: Residents of long-term care facilities (LTCF) are at risk of healthcare associated infections (HAI) and are often treated with antibiotics. In Germany a current HAI prevalence of 1.6 % and antibiotic use in 1.15% have been reported. However, data published on the current prevalence of multidrug-resistant organisms (MRDO) in LTCFs in Germany are scarce. Therefore, the prevalence of HAI, antibiotic use and presence of MDROs were investigated in LTCF residents in Frankfurt am Main, Germany. METHODS: A point prevalence study of HAI and antibiotic use according to the European HALT protocol (health care associated infections in long-term care facilities) was carried out; swabs from the nose, throat and perineum were analyzed for methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE). RESULTS: A total of 880 residents in 8 LTCFs were enrolled in the study in 2012. The study participants were 30% male, 46.7% were more than 85 years old, 70% exhibitied urinary or fecal incontinence, 11.4% had an indwelling urinary catheter and 0.1% a vascular catheter. Prevalence rates of HAI and of antibiotic use were 2.5 % and 1.5%, respectively. The prevalence of MDROs in 184 residents who agreed to being tested for MDROs was 9.2% MRSA, 26.7% ESBL and 2.7% VRE. CONCLUSION: The HAIs and antibiotic use were comparable to the German HALT data from 2010. Compared to other German studies there is a steadily increasing MRSA problem in German LTCFs. High and increasing ESBL rates have been detected in German LTCFs. Further studies are needed to confirm this trend, preferably encompassing molecular methods to study epidemiology.

[MRSA bloodstream infections according to the German obligation for notification - data and experience of the MDRO Network Rhine-Main, Germany, 2011]. / Meldepflicht MRSA in Blutkulturen - Daten und Erfahrungen des MRE-Netz Rhein-Main, 2011.

BACKGROUND: Since July 1st, 2009 in accord with the statuary order based on the German law for infectious diseases (Infektionsschutzgesetz), MRSA in blood and liquor have to be notified to the public health authorities. The aim of this extension of the notification to report is to improve the surveillance of nosocomial infections and the prevention of nosocomial MRSA infections. In this paper data of the notifications in the year 2011 within the MDRO-Net Rhine-Main, an association of 7 public health authorities in the region, are reported in order to investigate whether the aims of the obligation for notification could be achieved. RESULTS: In 2011, 138 MRSA bloodstream infections, including 1 MRSA in liquor culture, were notified to the 7 health protection authorities, resulting in an incidence rate of 5.6/100,000 inhabitants. In urban regions with more hospitals available, the incidence rate was higher than in rural districts with less medical facilities (6.9 vs. 4.4/100,000 inhabitants). Only 46 (35%) of the patients with MRSA cultured in their blood had been detected via anamnesis as patients on risk for MRSA, and 59 (45%) had been screened for MRSA on admission. The incidence rate in the different hospitals was 0.041 ± 0.031/1,000 patient days (range 0-0.145/1,000 patient days). CONCLUSIONS: For the first time, data on notification of MRSA cultures in blood specimen are published from a whole MRE Network in Germany encompassing >2.1 million inhabitants. Incidence rates per 100,000 inhabitants alone do not seem adequate to cope with the aims of the obligation for notification. Instead, reference to patient days in the respective clinic enables an external comparison to other medical institutions in the region and is a better base for discussion with these institutions on improvements of surveillance, screening and hygiene.

[Hygiene control visits in medical practices - topics to be focused on]. / Hygienebegehungen in Arztpraxen - Worauf ist besonders zu achten?

According to the "Protection against Infection Act", public health services are obliged to supervise and consult the hygienic conditions not only in hospitals but also in ambulatory medical practices in Germany. Firstly, in this paper basic principles on transmission routes of pathogenic germs and general remarks on the infection control visits as well as on the special regulations (i.e., German commission on hospital hygiene and infection prevention) are described. Secondly, crucial points to be considered in all medical practices are mentioned. Finally, special issues in different practices are reported, such as dermatology, gastroenterology, gynaecology, paediatrics etc. This article aims to support the public health departments in their task to prevent infections in patients and personnel in medical practices.·

[Ten years' German Protection against Infection Act. Evaluation of the implementation of infection control visits in the ambulatory medical setting]. / Rückblick auf 10 Jahre Infektionsschutzgesetz. Evaluation der Einführung der infektionshygienischen Überwachung ambulanter medizinischer Einrichtungen.

In 2001, the German Protection against Infection Act came into force, implementing a variety of new regulations. For the first time, obligatory infection control visits of the public health departments in surgical ambulatory practices were implemented, as well as optional infection control visits in all medical, dental and paramedical practices using invasive methods. Based on the data of the public health department of the city of Frankfurt am Main, Germany, an evaluation of this new regulation is given in this paper. First, prioritization of these new tasks was mandatory. First priority was given to the obligatory visits in surgical practices, second priority to the hygiene visits in practices performing endoscopy in gastroenterology as well as in urology and in practices of traditional healers, and third priority was given to all other doctors' practices. After receiving preliminary information and further training of the doctors etc., the control visits were performed by members of the public health department, using a checklist based on the guidelines of the German Commission on Hospital Infection Prevention ("Kommission für Krankenhaushygiene und Infektionsprävention"). Since 2001, more than 1100 infection control visits in medical practices in Frankfurt am Main were documented. Not only in surgical, but also in gastroenterological and urological practices great improvement could be achieved, regarding not only hand hygiene and reprocessing surface areas, but especially in reprocessing medical devices. In practices for internal medicine and those of general practitioners, errors in hand hygiene, skin antiseptic and surface disinfection also decreased. According to our results, especially regarding the improved quality of structure as well as quality of process and with regard to the public discussion on this hygiene topic, our evaluation is absolutely positive. The new regulation proved worthwhile.

[Oral health hygiene education programme for nursing personnel to improve oral health of residents in long-term care facilities 2010 in Frankfurt/Main, Germany]. / Schulung von Pflegepersonal in Altenpflegeheimen zur Verbesserung der Mundhygiene bei den Bewohnern - Interventionsstudie in Frankfurt am Main 2010.

BACKGROUND: Many studies have shown the urgent need for improving oral health hygiene in nursing home residents. Deficits in the knowledge of the personnel about dental and oral hygiene are often cited as one of the causes. Therefore, an oral health education programme was provided to the personnel of 20 nursing homes in Frankfurt/Main. Here the results of the assessment of the impact of the education programme on knowledge and attitudes of the personnel as well as on oral health of the residents are presented. METHODS: In May/June 2010, 471 nurses in 20 nursing homes in the Frankfurt/Main, Germany, received a two-hour education programme on oral health. The lessons were held by dentists with special education in geriatric dentistry. The personnel were asked to complete a questionnaire regarding knowledge and attitudes on oral health care before the education programme and 4-6 months afterwards. The oral health status of 313 residents (i. e., about 10% of the total residents) was examined by two dentists. Before and 4-6 months after education of the caregivers, the following data were recorded in the residents: number of teeth, caries, plaque index (PI), sulcus bleeding index (SBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). RESULTS: By attending the lessons, good improvements in knowledge of the caregivers could be obtained. The education programme was rated as very good/good by 85% of the nurses, having reduced their fear of oral care in the seniors and having gained more competence in practical oral hygiene procedures. Mean age of the residents was 80±13 years. About 32% of the residents were edentulous. Teeth were carious in 53% of the residents. Initially, one half of the residents exhibited plaque index>2, in 29% of the residents a severe and in 59% of them a very severe parodontitis was found (CPITN 3 or, respectively, 4). At 4-6 months after the education programme, an improvement in oral and dental hygiene of the residents could be demonstrated, significant for plaque index, cleanliness of the tongue and denture hygiene index. CONCLUSION: The positive assessment of the nursing personnel as well as the positive effects on oral hygiene in the residents are in agreement with the results of many other studies in many countries. Therefore, these education programmes will be continued in the long-term care facilities in Frankfurt/Main, Germany.·

[Hygiene in intensive care units in Frankfurt am Main, Germany]. / Hygiene auf Intensivstationen in Frankfurt am Main.

UNLABELLED: : The German Commission on Hospital Hygiene and Infection Prevention has published several recommendations regarding hygiene in the intensive care unit. Compliance with these recommendations was surveyed. METHODS: In 2005 and 2011, the intensive care units of all hospitals in Frankfurt am Main, Germany, were examined by members of the public health department, using a checklist based on the respective recommendations. RESULTS: Recommendations on the architecture and function of intensive care wards were almost fully complied with, except for the stipulated amount of space and nursing personnel. Compliance with recommendations for prevention of ventilator-associated pneumonia and for prevention of catheter-related bloodstream infections was excellent, with only some minor exceptions. Regarding hand hygiene, in 2011 fewer faults were documented than in 2005. All hospitals took part in the German project of the world-wide campaign "clean care is safer care." In 2005, device-associated infections were surveyed in 92% intensive care units, and in 2011 in all of them. By 2011, screening of methicillin-resistant Staphylococcus aureus had been established in all intensive care units. CONCLUSION: Most problems that were observed regarded a scarcity of space and of facilities for isolation of patients and of nursing personnel. Improvements were seen in hand hygiene and in screening for multidrug resistant organisms (MDRO).

Healthcare-associated infections in long-term care facilities (HALT) in Frankfurt am Main, Germany, January to March 2011.

Healthcare-associated infections (HAIs) are a potentially serious threat to elderly people living in longterm care facilities. Therefore, the European HALT (Healthcare-associated infections in long-term care facilities) project was launched in 2008. HAIs and the use of antibiotics were studied in all 40 nursing homes (100% response) in the city of Frankfurt am Main, Germany, from January to March 2011, using the HALT protocol. Of the 3,732 residents in the homes, 4.3% (n=161) had either signs or symptoms of infections and/or were on oral antibiotics. The most common infections were urinary tract infections (n=45; 1.2%), followed by infections of the respiratory tract (n=41; 1.1%) and skin except mycosis (n=25; 0.7%). The overall prevalence of oral antibiotic use was 2.4% (n=90). The most frequently prescribed oral antibiotics were quinolones (n=31), cephalosporins (n=19), penicillins (n=11) and co-trimoxazole (n=11). The prevalence of HAIs was about the same as that in a European pilot study carried out in November 2009 (5%), but was higher than in several national surveys carried out between May and September 2010 (1.6­3.6%).