[The SARS-CoV-2 Pandemic in Long-Term Care Facilities for the Elderly: Analysis of Data from Frankfurt am Main, Germany, March 2020 - September 2021]. / Die SARS-CoV-2-Pandemie in Altenpflegeheimen: Erkenntnisse und Analysen in Frankfurt am Main von März 2020 bis September 2021.

BACKGROUND: Residents in long-term care facilities (LTCF) are particularly vulnerable during the SARS-CoV-2 pandemic. In the first wave of the pandemic in many countries, 30-70% of all deaths from or with SARS-CoV-2 were LTCF residents, although their proportion in the population is typically less than 1%. Findings from LTCFs in Frankfurt am Main (March 2020-September 2021) are presented below and discussed in terms of necessary improvements. MATERIAL AND METHODS: The reports of positive PCR tests for SARS-CoV-2 in residents and staff of the LTCF in Frankfurt am Main and their symptoms were descriptively evaluated. In addition, the total deaths in nursing homes from 2018 to June 2021 were surveyed per quarter. RESULTS: In the first pandemic wave (March-May 2020), 111 SARS-CoV-2-positive LTCF residents were reported to the Public Health Department in Frankfurt am Main, of whom 40% were asymptomatic, 48% were hospitalized, and 23% died. In the subsequent pandemic phases through September 30, 2021, additional 1196 residents infected with SARS-CoV-2 were reported, with most of them being asymptomatic (70%); they were hospitalized less frequently (27%). Mortality was also lower (17.6%). Overall mortality in LTCF was 7.6% higher in 2020 than in 2019 and 1.1% higher than in the "flu year" of 2018. DISCUSSION: In contrast to the first wave, when only a few LTCF residents contracted COVID-19, in the second pandemic wave in autumn/winter 2020/21, with high incidences in the general population, SARS-CoV-2 outbreaks in LTCF in Frankfurt could not be prevented, despite extensive hygiene, infection prevention, and contact mitigation measures (including visitor restrictions) that massively limited residents' quality of life and their personal rights. Only when vaccination rates increased among residents and staff from April 2021 onwards, there were no massive outbreaks. To better protect LTCF residents, an appropriate balance was called for between protecting against infection and avoiding collateral damage by maintaining the freedom and quality of life of nursing home residents as best as possible.

[Legal Obligation to Notify Severe Clostridiodes difficile Infections - Data from Frankfurt am Main, Germany. Overview and Discussion]. / Meldepflicht für schwere Clostridiodes difficile ­ Infektionen ­ Daten aus Frankfurt am Main, 2014­2018. Bestandsaufnahme und Diskussion.

BACKGROUND: Clostridioides difficile (C. difficile) is the most frequently identified causative agent of antibiotic-associated diarrhea in industrialized countries. As early as 2007, severe C. difficile infections (CDI) were to be notified in Germany as a "threatening disease with an indication of grave danger to the general public". In 2016, the Notification Adjustment Ordinance put in force a duty to notify CDI with a clinically severe course. Here, the necessity and suitability of mandatory notification of severe CDI in Frankfurt am Main, Germany, 2014-2018 is examined. MATERIAL/METHOD: Cases of CDI reported to the health department Frankfurt am Main were compared with the C. difficile-associated deaths in Frankfurt for 2014-2018. The results were compared with data from the literature, the national reporting data according to the Infection Protection Act (IfSG), the mortality statistics, the hospital treatment data as well as the hospital surveillance data of the German hospital infection surveillance system for C difficile-associated diarrhea (CDAD). RESULTS: With the entry into force of the new Notification Adjustment Ordinance, the number of CDIs reported annually in Frankfurt am Main increased from 5-8 to 13-14; however, in all years (with the exception of 2016), the number of deaths (death-leading illness or previous cause) was -17-50 per year and thus well above the number of reported CDI-cases according to the German Infection Protection Act. CONCLUSION: The notification data from Frankfurt am Main show an approx. 2-fold lower score compared to the CDI-associated deaths. From the data of the Hospital Surveillance System (CDAD-KISS), it can be estimated that the majority of the cases are not notified. While an increase in CDI notifications is reported nationwide, there is a decrease in data from nationwide death statistics, hospital treatment data and CDI prevalence, and an increase in incidence of severe CDI. Therefore, and taking into account legal requirements of the IfSG and the options for action of the health authorities according to § 23 (4) Infection prevention act (IfSG), and regarding European recommendations and available data on CDI surveillance, the obligation to notify CDI should be lifted.

[The School Entrance Examination: Attempted Evaluation by Interviewing Parents, Pediatricians and Schools]. / Die Schuleingangsuntersuchung: Versuch einer Evaluation durch Befragung von Eltern, Kinderärzten und Schulen.

INTRODUCTION: In Germany, school entry examinations (SEU) are mandatory in all (federal) states, the scope and methods of investigation are laid down in state ordinances. The SEUs are performed by the pediatric services (KJGD) of the public health departments. An evaluation of the entire SEU is still pending. Therefore, in 2018, an evaluation of the SEU was carried out in the health department of the city of Frankfurt am Main by interviewing parents, schools and pediatricians. METHOD: With specifically developed questionnaires, parents as well as administrators of elementary schools and pediatricians were asked about their assessment of and their experiences with the SEU. Certain sentences were to be rated on a 5-point Likert scale. For the evaluation, the positive answers (totally agree / agree) and the negative answers (disagree / strongly disagree) were summarized. RESULTS: A total of 2,021 parental, 46 school and 37 physician questionnaires were evaluated. The response rate of parents was 90%, that of schools and pediatricians 45% and 56%, respectively and thus significantly worse. Ninety-one percent of parents rated the SEU as useful in addition to their pediatrician check-ups, and 94% considered hearing and vision tests to be particularly important. Eighty-five percent considered the SEU as an important means of undertaking support measures before school entry. Ninety-one percent of school administrators rated the results of the SEU as helpful, 26% of them stated that key areas, including social behavior were given insufficient consideration in the SEU. Many school administrators wanted more support from the health department, e. g. inclusion issues (59%), parenting evening lectures (61%) or general health support (74%). Ninety-one percent of pediatricians also rated the SEU positively. However, misjudgments of the school doctors and uncertainty of the parents as well as rare exchanges/communication were criticized. CONCLUSION: The overall feedback was positive and the significance of the SEU was not questioned. However, the KJGD should try to better meet the needs of schools for more support and pediatricians' desire for better cooperation. Through a modification of the SEU, capacities could be created for other important tasks of the KJGD, for instance the examination of school newcomers from foreign countries, health promotion in schools, and medical advice to schools.

[Children in the COVID-19 pandemic and the public health service (ÖGD) : Data and reflections from Frankfurt am Main, Germany]. / Kinder in der COVID-19 Pandemie und der Öffentliche Gesundheitsdienst (ÖGD) : Daten und Überlegungen aus Frankfurt am Main.

BACKGROUND: The measures taken to combat the COVID-19 pandemic have severely restricted the opportunities for the development of children. This paper will discuss the reporting data of children and the public health department's activities against the background of the restrictions of school and leisure time offers as well as sports and club activities. MATERIALS AND METHODS: Reporting data from Frankfurt am Main, Hesse, were obtained using a SURVStat query for the calendar weeks 10/2020-28/2021 and from SURVNet (until 30 June 2021). Contact persons (CP) of SARS-CoV­2 positive persons from schools and daycare centers were screened for SARS-CoV­2 by PCR test. These results and those of rapid antigen testing, which has been mandatory for schoolchildren since April 2021, are presented. RESULTS: Until Easter break, the age-related seven-day incidence values per 100,000 for children 14 years of age and younger were lower than the overall incidence; it was only higher after rapid antigen-testing was mandatory for schoolchildren. Most children with SARS-CoV­2 had no or mild symptoms; hospitalization was rarely required and no deaths occurred. Contact tracing in schools and daycare centers found no positive contacts in most cases and rarely more than two. Larger outbreaks did not occur. CONCLUSION: SARS-CoV­2 infections in children appear to be less frequent and much less severe than in adults. Hygiene rules and contact management have proven themselves effective during times with high incidences in the local population without mandatory rapid antigen testing - and even with a high proportion of variants of concern (alpha and delta variants) in Germany. Against this background, further restriction of school and daycare operations appears neither necessary nor appropriate.

[Toilet Hygiene in Schools: an Old and Still Current Topic. Results of a Survey of School Administrators and Students in Frankfurt am Main, 2018]. / Toilettenhygiene in Schulen: ein altes und immer noch aktuelles Thema. Ergebnisse einer Umfrage bei Schulleitungen und Schülern in Frankfurt am Main, 2018.

BACKGROUND: Due to numerous complaints regarding the bad condition of the toilets in schools in Frankfurt am Main, a structured survey was conducted in schools in June 2018. The objectives of the survey were: investigation of problem situations and collection of good-practice examples METHODS: One questionnaire was developed for the school management and another one for the students, to be completed by each class. Experiences and suggestions for improvement were asked for from both the management and the students RESULTS: All 147 schools in Frankfurt were contacted. 86 directors (57.8%) returned the questionnaires for the management, out of 107 (72.8%) of the schools, 982 class questionnaires were completed and returned. 18.6% of directors were satisfied with the condition of the toilets; as success factors they listed pedagogical measures and provision of sufficient hygiene articles (each 14%) as well as increased cleaning frequency (12%). As a cause of problems, 73% of the directors reported student behavior. Suggestions for improvement included: more frequent cleaning, additional supervisors, construction/renovation work and a higher budget for toiletries. About 10% of the 982 classes had no complaints about their school toilets, 92% of the classes complained of stench, 85% of dirt, and 70% of missing toilet paper. As a reason for problems, 89% of the classes stated student behavior. Suggestions for improvement of the students ranged from improved cleaning and more cleaning personnel, more personnel for control and supervision, etc. to technical solutions such as a chip and code system. CONCLUSIONS: The survey confirms the need for addressing the problems related to school toilets. Both school directors and classes most often cited user behavior and vandalism as the cause, well ahead of problems with cleaning or old toilets. Therefore, although improved cleaning is often required, it is not enough. A change in the behavior of students ís necessary as well. The proposed improvement measures should be tested and if found to be effective, implemented.

[Multidrug Resistant Organisms (MDRO) in Rehabilitation: Prevalence and Risk Factors for MRGN and VRE]. / Multiresistente Erreger (MRE) in der Rehabilitation: Prävalenz und Risikofaktoren für MRGN und VRE.

BACKGROUND: After a first large-scale study on multi-drug resistant organisms (MDRO) in rehabilitation facilities in 2014, the Rhine-Main network on MDRO carried out another investigation in 2019. With regard to the recently published KRINKO recommendations on multidrug resistant enterococci, now vancomycin -resistant enterococci (VRE) and multi-drug resistant gram-negative pathogens (3MRGN and 4MRGN, i. e. gramnegative organisms resistant against 3 resp. 4 groups of antiinfectiva) were investigated. MATERIAL AND METHODS: A total of 16 hospitals took part, including one clinic for early neurological rehabilitation (ENR). Patient participation was voluntary. Rectal swabs were analyzed in a medical-microbiological laboratory (certified according to DIN ISO 15189) using standard methods (including MALDI-TOF-MS and VITEK 2 resistance testing according to EUCAST). By using the standardized questionnaire of the Europe-wide HALT examination (healthcare associated infections in long-term care facilities), patient characteristics (age, gender, hospital, surgical and MDRO medical history, Medical devices, current antibiotic therapy etc.) were collected. RESULTS: 928 patients took part in the study, 895 from general rehabilitation facilities (GR) and 33 from early neurological rehabilitation (ENR). 65% of GR patients (ENR 100%) had been hospitalized in the previous 6 months, 29% (ENR 100%) of the patients had been admitted directly from a hospital, 22% (ENR 64%) had received antibiotic therapy in the last 3 months. Medical devices were rarely used in GR patients with 1% overall, but often in the ENR with 61% urinary catheters and 36% vascular catheters. 2.2% (ENR 33.3%) of GR patients were colonized with VRE and 6.7% (ENR 18.2%) with 3MRGN; one patient exhibited a 4MRGN (ENR 0). DISCUSSION: Compared to our previous study, there were no significant changes in the patient characteristics. The VRE prevalence was low at 3.3%, the prevalence of 3MRGN was higher compared to 2014 (7.1% vs. 3.6%). Risk factors for VRE and 3MRGN colonization (significant increased odds ratio) were: history of hospital treatment and an increased need for care due to restricted mobility, incontinence and disorientation. In addition, previous antibiotic treatment and skin barrier injuries due to Medical devices or wounds were detected as further risk factors for VRE colonization.

[Mandatory notification of infectious diseases and agents in Germany: development and suggestions for improvement]. / Meldepflichten für Infektionskrankheiten und Infektionserreger in Deutschland: Entwicklung und Verbesserungsvorschläge.

With the entry into force of the Infection Protection Act (IfSG) in 2001, the reporting obligations for infectious diseases and infectious agents were placed on a new foundation. For the first time, a distinction was made between an obligation for the notification of infectious diseases by physicians and a notification obligation for infectious agents by laboratories. The aim was to reduce the notification burden on physicians and thus to improve the quality of the notifications. Since then, numerous new obligations for notifications have been added.The aim of this work is to describe and discuss the mandatory notification of infectious diseases in Germany on the basis of their development - compared to previous regulations in Germany (Federal Communicable Diseases Act) as well as international and Europe-wide recommendations (IHR; decisions of the EU Commission 1999, 2018) - and to submit suggestions for improvement.Regarding the considerable increase in reporting requirements and reports in recent years, and the fact that the IfSG provides other surveillance systems in addition to mandatory reporting, the mandatory reporting system should be focused on the necessary reporting requirements. In a first step, the proposed abolition of the mandatory reporting of noroviruses and rotaviruses could relieve both the notifiers and the health authorities, thus enabling more efficient reporting and more intensive and better investigation by the health authorities.

[Surveillance of antibiotic agents according to § 23 of the German Infection Protection Act-data and results from hospitals in Frankfurt am Main, Germany, 2012-2017]. / Antibiotika-Verbrauchs-Surveillance nach § 23 Infektionsschutzgesetz ­ Daten und Erfahrungen aus den Krankenhäusern in Frankfurt am Main, 2012­2017.

BACKGROUND: Since 2011, German hospitals have been requested to record and evaluate antibiotic use in their institution. In this publication, the use of antibiotics in hospitals belonging to the administrative district Frankfurt/Main between 2012 and 2017 is presented and discussed with regards to the targets set in 2014. These targets are to improve the perioperative prophylaxis, reduce the use of cefuroxime, and increase the penicillin/cephalosporin ratio. METHODS: Since 2012, hospitals in Frankfurt/Main have been transmitting the defined daily doses (DDD) of all antibiotics used, the absolute number of patients, and their days of treatment. Since 2013, the data have also distinguished between intensive care and other units. The Frankfurt health authority calculated the total number of antibiotics and the DDD/100 patient days for all hospitals combined as well as for every hospital compared to each other. RESULTS: From 2012 to 2017, the number of absolute annual patient days increased from 1,592,161 to 1,615,180. Antibiotic use decreased from 1,073,975 DDD to 953,349 DDD, leading to a decrease from 67.5 DDD per 100 patient days to 59.0 DDD per 100 patient days. Cefuroxime was the most frequently used antibiotic in all hospitals. The use of cefuroxime showed a significant decrease between 2012 and 2017 (from 250,398 in 2012 to 165,160 DDD in 2017, a decrease of 34%). The use of ceftriaxone was reduced by 27%, ciprofloxacin by 9%, and levofloxacin by 16%. DISCUSSION: The targets set in 2014 were reached in the entirety of Frankfurt hospitals. However, there were significant differences between the hospitals taking part. The results were given as feedback to the hospitals in order to support their efforts in further improving antibiotic stewardship.

[Heat-related morbidity: real-time surveillance via rescue service operations data from the interdisciplinary care capacity proof system (IVENA)]. / Hitzeassoziierte Morbidität: Surveillance in Echtzeit mittels rettungsdienstlicher Daten aus dem Interdisziplinären Versorgungsnachweis (IVENA).

BACKGROUND: In addition to mortality data, hospital admission, emergency department visits, and emergency service calls data are used for the surveillance of heat-related morbidity. We report on heat-associated morbidity in Frankfurt am Main from 2014-2018 using the web-based care capacity proof system (IVENA) of the rescue service operations. MATERIAL AND METHODS: In the web-based IVENA system, all patients with prehospital emergency care are recorded in real time. The rescue service operations were evaluated in the summer months (June-August) from 2014-2018 in Frankfurt am Main as a whole and separately according to various heat-related diagnoses. The current temperature data of the Frankfurt East measuring station were obtained online as hourly values from the website of the Hessian Institute for Nature Conservation, Environment and Geology ( www.hlnug.de ). Temperature maxima ≥32 ℃ for at least 5 days were defined as a "heatwave." RESULTS: From 2014-2018, three heatwaves occurred according to the definition above: in 2015, 2016, and 2018, with an extremely long heat period in 2018 (17 days). During the heatwave in 2015, the highest excess morbidity was noted: +17% total ambulance service operations and +198% emergency service operations due to heat-related disease disorders. The evaluation of the long heat period in 2018 showed that with increasing duration of the heat period, the emergency rescue service operations due to total heat-associated morbidity remained high with increasing emergency service operations due to exsiccosis and unclear fever. CONCLUSION: The data obtained by the IVENA system enable a current and complete assessment of severe acute diseases in the city or in the respective rescue service area in real time. Health effects of heat events can thus be investigated in real time and the system can be used as an early warning system for prevention.

[Personal preconditions for the prevention of nosocomial infections-guidelines of the German Commission for Hospital Hygiene and Infection Prevention (KRINKO), federal state hygiene regulations in Germany, and compliance by hospitals in Frankfurt am Main]. / Personelle Voraussetzungen zur Prävention nosokomialer Infektionen ­ Empfehlungen der KRINKO und Verordnungen der Länder sowie deren Umsetzung in Frankfurt am Main.

According to the amendment of the Infection Protection Act (2011), § 23, 8, all federal states in Germany had to pass their own hospital hygiene regulations, in which the need for hygiene specialists in a hospital is defined.This publication explains in its first part the differences between the nationwide Commission for Hospital Hygiene and Infection Prevention (KRINKO) regulations and the hygiene regulations of the different federal states (Hesse, Bavaria, etc.). All federal states - with the exception of Hesse (Hessian Hygiene Regulation, HHygVO) - refer to the relevant expert recommendations of KRINKO.In a second part of this publication, we highlight differences between KRINKO and HHygVO with the example of hospitals in the city of Frankfurt. In 2017, all Frankfurt hospitals had the necessary hygiene specialists (authorized hygiene practitioners, infection control nurses, authorized hygiene care nurses). However, the need for hospital hygienists could not be met, because there is an insufficient number of physician specialists for hospital hygiene available in Germany.The hospitals cannot solve this problem on their own - a political, superordinate decision and regulation must be made, i. e. by regulation and financial support for the advanced training of post-graduate physicians in hygiene. This is important since only experienced hospital hygienists can instruct or supervise hygiene specialists-in-training.

[School Entrance Examination for Lateral Entrants - What Can and What Should They be Able to Do? A Discussion Contribution Based on the Data from the Health Authority Frankfurt am Main 2006-2016]. / Schuleingangsuntersuchung bei Seiteneinsteigenden ­ was kann, was soll sie leisten? Ein Diskussionsbeitrag auf Grundlage der Daten aus dem Gesundheitsamt Frankfurt am Main 2006­2016.

QUESTION: The medical investigation of school beginners is one of the essential tasks of the child and youth services of the health authorities. While in all federal states in Germany, the examination of all school beginners is legally clearly stipulated, the situation for "lateral entry", that is, children of school age, who are moving from a foreign country to a local German community and attending school there, is not clearly regulated in the respective school laws. This article presents the experiences of the lateral entry investigations in Frankfurt am Main. METHOD: All children of school age who moved to Frankfurt from abroad undergo a health check. This encompasses a standardized questionnaire-based history with the help of interpreters, including a review of the available vaccination document (case history sheets are available in different languages), an eye examination, hearing test and a physical examination. Children over the age of 15 who came from countries with a high prevalence for tuberculosis had chest x-ray. RESULTS: Between 2006 and June 2016, a total of 8245 children and adolescents were examined, in 4% of the children abnormalities in hearing, and in 22% in visual screening showed noticeable problems, with an increasing trend in recent years. The vaccination status was unknown in two-thirds of the children, one quarter of the children were sufficiently vaccinated against tetanus, diphtheria, polio and pertussis, and 19.5% were immunized against measles (vaccine or disease). Diseases of the respiratory tract, the heart and the circulation were predominant with a total of 4%, followed by musculoskeletal disorders with 3%. Lice infestation was found in 1.7% of children. In 0,7% of 2171 children with chest-X-rays, a conspicuous pulmonary lesion was diagnosed, but no tuberculosis. CONCLUSION: The focus of the lateral entrance examination is a school-related health status. On the basis of experience gained in Frankfurt am Main, it should be pointed out that investigations by the lateral entrants from other countries seem necessary, in particular visual and hearing screening, physical examination and checking the vaccination status, possibly in combination with vaccination. On the other hand, a detailed developmental screening does not appear to be urgent in the case of pupils who will be starting compulsory school, in whom there is no chance for additional encouragement before the start of school.

[The School Entry Health Examination: A Critical View of History and Status Quo.] / Die Schuleingangsuntersuchung: Ein kritischer Blick auf Historie und Status quo.

At the end of the 19th century, the school entrance medical examination of all school beginners was established in Germany. The focus was on exclusion of infectious diseases and illnesses that could make school attendance more difficult or worsen during the school visit. In the middle of the 20th century the concept of "school maturity" came to the foreground. Different "school maturity concepts" were applied but abandoned because they could not withstand an evaluation. Meanwhile, the concept of "school maturity" has been replaced by the concept of "school ability". The question no longer arises as to whether or not a child can be taught at school, but rather the assistance and support with which this can be achieved. Today, the school entrance medical check-up in nearly all the federal states includes, in addition to a medical history, an assessment of the precautionary and vaccination status, a visual and hearing test as well as assessment of the development of the child and his/her individual support requirements, especially in the field of cognition and language. In almost all German federal states, the school entrance examinations use up considerable resources of the pediatric and adolescent services in the public health departments. In the paper presented, this is critically discussed, and a discourse is suggested as to whether these resources could be used more effectively in terms of child health considering changed social conditions, such as the mandatory health checks in childhood in many federal states, the increase of immigrants from other countries, in particular asylum seekers, or the "Inclusion", i. e. with closure of special-needs schools and the associated challenges in the regular schools.

[Health Impact of the Heatwave of 2015: Hospital Admissions in Frankfurt/Main, Germany]. / Morbidität durch Hitze ­ eine Analyse der Krankenhauseinweisungen per Rettungseinsatz während einer Hitzewelle 2015 in Frankfurt/Main.

Heatwaves are gaining in importance due to increasing climatic changes. They can impair health and increase mortality. A comparison of studies is difficult because of differences in the definition of a heatwave used and/or different populations studied. In this study, morbidity data were collected using the web-based IVENA system. This system registers hospital admissions with diagnosis by the emergency medical services. We analysed hospital admissions in Frankfurt/Main during June-August of 2014-2016. These periods included a heatwave in July 2015 (per definition>32°C for at least 5 days/more than 4 days). On days with "heatwave", there was a 22% increase in hospital admissions of patients brought in by the emergency services (excess morbidity). Considering only "heat-related diagnosis", the increase was 300%. In addition to the increase in hospital admissions on "heatwave" days, there was also a direct correlation between temperature and hospital admissions over the summer days. Using the data on hospital admission of patients brought in by the emergency services turned out to be a valid marker for "heat morbidity".

Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015.

Many refugees arriving in Germany originate or have travelled through countries with high prevalence of multidrug-resistant Gram-negative organisms. Therefore, all unaccompanied refugee minors (<18 years-old) arriving in Frankfurt am Main between 12 October and 6 November 2015, were screened for multidrug-resistant Enterobacteriaceae in stool samples. Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) were detected in 42 of 119 (35%) individuals, including nine with additional resistance to fluoroquinolones (8% of total screened), thus exceeding the prevalences in the German population by far.

[Surveillance of antibiotic consumption- a new task for public health services : Data from Frankfurt's hospitals between 2012 and 2014]. / Antibiotika-Verbrauchs-Surveillance - Eine neue Aufgabe für Kliniken und auch für den öffentlichen Gesundheitsdienst : Daten aus den Kliniken in Frankfurt am Main, 2012 bis 2014.

BACKGROUND: Given the increase of antibiotic resistant bacteria the requirement for hospitals and ambulatory services to collect and analyze antibiotic consumption data was stipulated in the Protection against Infection Act (IfSG) in 2011. It is the duty of the public health offices to supervise the compliance with these specifications. Below, the antibiotic consumption data of all hospitals in Frankfurt am Main between 2012 and 2014 are reported and the supervisory activities presented. METHODS: Hospitals collect the antibiotic consumption data according to the legal requirements and provide the data in the form of defined daily doses (DDD) per active substance as suggested in the recommendations for the implementation of the law by the Robert Koch-Institute. Given the number of patient days the DDD/100 patient days could be calculated allowing a comparison between the hospitals. In 2015 the public health office additionally collected organizational and structural data on antimicrobial consumption. RESULTS: With more than 1.5 million patient days per year and over a million DDD, the consumption in the year 2012 was 67.5 DDD/100 patient days (pt days) and 66.0 DDD/100 pt days in the year 2014, with a range of 26.4 to 86.7 DDD/100 pt days in the individual hospitals. In 2012 Cefuroxim made up for 24 % of total consumption with 256,343 DDD, followed by Ciprofloxacin, Ceftriaxon and Levofloxacin with over 6 % each and with no significant changes from 2012 through 2014. In 2012 the carbapenems were the fourth most frequently prescribed group of antibiotics with 65,772 DDD or 4.1 DDD/100 pt days after the cephalosporins (408,519 DDD; 25.7 DDD/100 pt days), penicillins (215,591 DDD; 13.5 DDD/100 pt days) and the fluoroquinolones (144,195 DD; 9.1 DDD/100 pt days). However, the consumption of carbapenems increased up to 2014 by 24 % to 82,007 DDD. All 16 hospitals had established an antibiotic consumption surveillance system including the evaluation of the data, however, the availability for the entire staff was not yet fully implemented. CONCLUSION: This is the first report of antibiotic consumption data from the hospitals of an entire city. After compilation and processing of the data the public health office fed back this information to the facilities during on-site visits in 2015 - in an anonymized comparison with other hospitals of the region. This forces the hospitals to deal intensely with the data, with the goal of using antibiotics more appropriately in order to minimize the selective pressure due to mis- and overuse of antibiotics. The forthcoming years will clarify the effect of the antibiotic surveillance on antibiotic consumption in these hospitals.

[Multidrug-resistant organisms (MDRO) in patients in outpatient care in the Rhine-Main region, Germany, in 2014: Prevalence and risk factors]. / Multiresistente Erreger bei Patienten ambulanter Pflegedienste im Rhein-Main-Gebiet 2014 : Prävalenz und Risikofaktoren.

BACKGROUND: Data on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in outpatient care are scarce and those on the prevalence of multidrug-resistant Gram-negative bacteria (MRGN) are lacking completely. Therefore, the network on multidrug-resistant organisms (MDRO) in the Rhine-Main region (MRE-Netz Rhein-Main) performed a multicenter study on current prevalence data and risk factors for MDRO. MATERIALS AND METHODS: Characteristics of all patients were obtained according to a modified healthcare-associated infections in long-term care facilities (HALT) questionnaire and swabs from the nares/throat and anus were tested for MRSA and extended-spectrum beta-lactamase (ESBL)/MRGN. Risk factors were calculated via odds ratios. RESULTS: Ten nursing services with 486 patients participated in this study, 269 patients agreed to having swabs of the nares/throat taken, and 132 patients had anal swabs. MRSA was detected in 3.7%, and ESBL/MRGN in 14.4% of the patients (6.8% ESBL, 7.6% MRGN, 0% MRGN). Risk factors for MRSA were high dependency on care (stage 3 or above; OR 5.1), antibiotic use during the preceding 3 months (O R 3.7), hospital stay during the last 6 months (OR 4.3), and a positive history for MRSA (OR 18.1). Incontinence and preceding hospital stays proved to be risk factors for ESBL colonization (OR 9.5 or 6.5), whereas risk factors for MRGN colonization were a high level of care dependency (OR 7.5), urinary catheter (OR 8.3), percutaneous endoscopic gastrostomy tube and other stomata (OR 6.2), and artificial respiration (OR 5), in addition to a positive history for MRSA (OR 20) and ESBL (OR 6.7). CONCLUSION: Considering the high prevalence of colonization with MDRO in outpatient care, nursing services must be competent in caring for such patients: good hygiene procedures, including hand hygiene and appropriate handling in wound management, punctures and injections, with catheters, stomata, and if necessary with artificial respiration should be practiced. The guidelines of the German Commission on hospital hygiene and infection prevention should also be observed.

[Cleaning and disinfection of surfaces in hospitals: Data on structure, process and result in the Frankfurt/Main Metropolitan Area]. / Flächenreinigung und -desinfektion im Krankenhaus - Struktur-, Prozess- und Ergebnisqualität : Ergebnisse der infektionshygienischen Überwachung in Frankfurt am Main, 2014.

INTRODUCTION: In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. METHODS: All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. RESULTS: Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. CONCLUSION: The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.