[How many hospital insurance claims are based on infection control failures?]. / Wie häufig kommt es wegen Hygienefehlern zu Anspruchsanmeldungen an die Krankenhäuser?

BACKGROUND AND OBJECTIVE: It can be expected that hospital insurance claims based on health care-associated infections (HCAI) will increase in German hospitals because of growing media and patient interest in this topic. It was the aim of this study to determine the percentage of insurance claims because of HCAI among all potential cases of avoidable HCAI. METHODS: Data of a core group of 254 hospitals continuously working with one of the largest German hospital insurance companies (ECCLESIA) over an eleven-year period were used. The observed number of cases caused by infection control failures (ICF) was compared with the potential number of avoidable HCAI in the entire patient group treated in these hospitals. The type of the failure as well as the probability of an actual ICF were evaluated in each case of ICF by a team of experts. RESULTS: A hospital insurance claim was made in only 0.2 % of all avoidable HCAI cases. Among the 117 cases with payments exceding 700 Euro, only 39 were found to have had a specific infection control problem. Fewer than half of these cases were considered as probable infection control failures by the experts in this field. CONCLUSION: Hospital insurance claims because of HCAI are still rare in German hospitals. In the group of insurance claims because of ICF, some cases had been classified incorrectly.

Worldwide Outbreak Database: the largest collection of nosocomial outbreaks.

Epidemiological findings of a single outbreak event may not be generalized; however, the characteristics of a typical outbreak can be determined on the basis of a large number of similar events. The Outbreak Database ( http://www.outbreak-database.com ) is the largest collection of nosocomial outbreaks currently available-and is still expanding. Articles are filed systematically, enabling those on a specific parameter of interest to be retrieved quickly. As such, this database is an extremely valuable tool on many medically related fronts, such as for educating other medical personnel, providing relevant information during the investigation of an acute outbreak, or addressing scientific-oriented questions. Several systematic reviews on a wide range of subjects, including sources of infections, types of pathogens, routes of transmission, appropriate infection control measures, and patients at risk of infection, have already been published based on information contained in this database. As this database may be used free of charge, all medical staff in the field of infection control, hygiene, and hospital epidemiology should be aware of its existence.

Outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a surgical intensive care unit.

Infection control personnel performing surveillance activities noticed a cluster of patients with isolates of carbapenem-resistant Pseudomonas aeruginosa (CRPA) in the surgical intensive care unit (SICU) of a German University Hospital. An outbreak investigation including a descriptive analysis, a case-control study comparing 15 CRPA case patients with 18 patients with carbapenem-susceptible P. aeruginosa, environmental sampling and pulsed-field gel electrophoresis (PFGE) typing of P. aeruginosa isolates was carried out. Fifteen patients acquired CRPA in the SICU during the outbreak period between 1 July 2006 and 31 October 2006 and PFGE typing of 11 available patient isolates revealed two outbreak strains as well as sporadic CRPA isolates. Both outbreak strains were resistant to penicillins, cephalosporins, carbapenems, aminoglycosides and quinolones, and remained susceptible only to colistin. The most likely mode of transmission was cross-transmission between patients during postoperative wound care with abdominal and/or thoracic drains (odds ratio: 64.33; 95% confidence interval: 5.32-999) and therapy with quinolones (48.37; 3.71-999) being independent risk factors for acquisition of CRPA. No further clusters of CRPA cases were observed after implementation of contact isolation precautions and after healthcare workers were made aware of the likely mode of transmission. This study shows the complex epidemiology of CRPA in a SICU including cross-transmission of two CRPA strains related to postoperative wound care.

Surveillance of Clostridium difficile-associated diarrhoea with the German nosocomial infection surveillance system KISS (CDAD-KISS).

A study of 2856 Clostridium difficile -associated diarrhoea (CDAD) patients from 34 hospitals in Germany was carried out over a period of 12 months in 2007. The overall incidence of CDAD cases was 46.5 per 10,000 admitted patients, or 6.6 cases per 10,000 patient-days. Seventy-three percent of cases were considered to be nosocomial and 8.4% were classified as severe. There was a wide range in the incidence of CDAD between the hospitals (interquartile range [IQR] 3.2-9.2 cases per 10,000 patient-days), and the incidence of nosocomial cases (IQR 1.7-6.7 per 10,000 patient-days). The differences between the hospitals were in line with the differences in local diagnostic and infection control procedures. The overall incidence in the hospitals participating in the surveillance system was much higher than that in the discharge data from the whole of Germany in 2006. This may be due to more diligent ICD9 coding by the clinicians during an active surveillance strategy. However, the group of hospitals participating in the study was small and may not be representative of the situation in the country as a whole.

Autologous epidermal cells can induce wound closure of neurotrophic ulceration caused by trigeminal trophic syndrome.

Trigeminal trophic syndrome is an extremely rare complication following surgical ablation of the trigeminal nerve or after alcohol injection or thermocoagulation of the Gasserian ganglion. These lesions show a poor healing tendency and sometimes persist for years. The therapeutic results of local wound care with ointments and wound dressings are often unsatisfactory, and those of plastic surgery are variable. In the case presented, the skin area affected by neurotrophic ulceration is successfully treated with autologous cultivated epidermal cells. This form of tissue engineering is already a clinically established procedure for treating burns and chronic wounds. The results show for the first time that transplantation of in vitro cultivated epidermal cells can induce tissue regeneration and may be an effective tool in the treatment of neurotrophic ulcerations in the facial region.