[Long-term care facilities-the COVID-19 pandemic as an urgent call: infection prevention, control measures, and factors influencing the health of residents]. / Alten- und Pflegeheime ­ die COVID-19-Pandemie als Mahnung: Infektionshygienische Maßnahmen und Einflussfaktoren auf die Gesundheit der Bewohnenden.

The COVID-19 pandemic once again highlighted the vulnerability of residents of long-term care facilities due to their increased risk of a severe or fatal course of COVID-19. To protect the residents in the face of high incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV­2) in the general population, a number of measures for infection protection were recommended, which led to a decrease of COVID-19 case numbers and deaths in the facilities during the pandemic. However, factors in the facilities that hampered the implementation of these measures and represented a significant impact on the health of the residents also became visible.The challenges concern working conditions (e.g., lack of staff, both in general and with corresponding competencies, and work-related stress), the care of residents (e.g., medical and psychosocial), and structural as well as facility-related factors (e.g., facility size).Approaches to these problems indicate that a successful implementation of infection control measures should be part of a concept for redesigning the work and living conditions of the staff and residents of the facilities. It is important to note that infection control should not be planned exclusively with regard to future pandemics, but is of relevance for health risks that already exist in the facilities, such as healthcare-associated infections, antibiotic resistances, or influenza.

[Measures to cope with the COVID-19 pandemic in Germany: nonpharmaceutical and pharmaceutical interventions]. / Maßnahmen zur Bewältigung der COVID-19-Pandemie in Deutschland: nichtpharmakologische und pharmakologische Ansätze.

When the emerging novel SARS-CoV­2 virus first appeared in December 2019, neither specific therapeutic options nor vaccinations were available. The role of nonpharmaceutical interventions (NPIs) became of central importance. At the Robert Koch Institute, a multilayer strategy consisting of population-based and individual preventive measures to control the pandemic was developed, which built upon existing influenza pandemic plans as well as generic plans. This paper explains the recommended NPIs and illustrates the pharmaceutical approaches developed in parallel.Among others, general contact bans, providing material for infection prevention and control, ban of events, closing educational institutions, and restricting travel are counted among population-based measures. Additional individual preventive measures are necessary, e.g., keeping a minimum distance, reducing contacts, and wearing a mouth-nose covering as well as quarantine and isolation. Measures within the health system are based on recommendations of the Commission on Hospital Hygiene and Infection Protection (Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)) and specified and implemented by professional societies. Since November 2020, an antiviral therapy with remdesivir and treatment with the glucocorticoid dexamethasone have been available as pharmaceutical interventions. Monoclonal antibodies are at this time not approved. Therapeutic anticoagulation is recommended.Recommendations are constantly adapted to the increasing knowledge on the pathogen and its means of transmission. A challenge is to strengthen the trust of the population. Many measures have to be applied on an individual basis in order to work together.

The Containment Scouts: First Insights into an Initiative to Increase the Public Health Workforce for Contact Tracing during the COVID-19 Pandemic in Germany.

The COVID-19 pandemic in Germany has demanded a substantially larger public health workforce to perform contact tracing and contact management of COVID-19 cases, in line with recommendations of the World Health Organization (WHO). In response, the Robert Koch Institute (RKI) established the national "Containment Scout Initiative" (CSI) to support the local health authorities with a short-term workforce solution. It is part of a range of measures for strengthening the public health system in order to limit the spread of SARS-CoV-2 in Germany. The CSI is an example of how solutions to address critical health system capacity issues can be implemented quickly. It also demonstrates that medical or health-related backgrounds may not be necessary to support health authorities with pandemic-specific tasks and fulfil accurate contact tracing. However, it is a short-term solution and cannot compensate for the lack of existing qualified staff as well as other deficits that exist within the public health sector in Germany. This article describes the structure and process of the first phase of this initiative in order to support health policymakers, public health practitioners, and researchers considering innovative and flexible approaches for addressing urgent workforce capacity issues.

The epidemiology of carbapenem resistance in Acinetobacter baumannii complex in Germany (2014-2018): an analysis of data from the national Antimicrobial Resistance Surveillance system.

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii complex (CRABC) has globally emerged as a serious public health challenge. This study aimed to describe epidemiological trends and risk factors of carbapenem resistance in A. baumannii complex isolates in Germany between 2014 and 2018. METHODS: We analysed 43,948 clinical A. baumannii complex isolates using 2014 to 2018 data from the German Antimicrobial Resistance Surveillance system. We applied descriptive statistics and uni- and multivariable regression analyses to investigate carbapenem resistance in A. baumannii complex isolates. RESULTS: The proportion of carbapenem resistance in clinical A. baumannii complex isolates declined from 7.6% (95% confidence interval [95% CI] 4.4-12.7%) in 2014 to 3.5% (95% CI 2.5-4.7%) in 2018 (adjusted OR [aOR] 0.85 [95% CI 0.79-0.93, p ≤ 0.001]). Higher mean CRABC proportions for 2014 to 2018 were observed in secondary care hospitals (4.9% [95% CI 3.2-7.5%], aOR 3.6 [95% CI 2.4-5.3, p ≤ 0.001]) and tertiary care hospitals (5.9% [95% CI 3.0-11.2%], aOR 5.4 [95% CI 2.9-10.0, p ≤ 0.001) compared to outpatient clinics (1.3% [95% CI 1.1-1.6%]). CRABC proportions in hospitals varied between German regions and ranged between 2.4% (95% CI 1.6-3.5%) in the Southeast and 8.8% (95% CI 4.2-17.3%) in the Northwest. Lower CRABC proportions were observed in younger patients (< 1 year: 0.6% [95% CI 0.2-1.3%]; 1-19 years: 1.3% [95% CI 0.7-2.5%]) than adults (20-39 years: 7.7% [95% CI 4.4-13.0%]; 40-59 years: 6.2% [4.2-8.9%]; 60-79 years: 5.8% [95% CI 4.0-8.3%]). In the 20-39 year old patient age group, CRABC proportions were significantly higher for men than for women (14.6% [95% CI 8.6-23.6%] vs. 2.5% [95% CI 1.3-4.5%]). A. baumannii complex isolates from lower respiratory infections were more likely to be carbapenem-resistant than isolates from upper respiratory infections (11.4% [95% CI 7.9-16.2%] vs. 4.0% [95% CI 2.7-6.0%]; adjusted OR: 1.5 [95% CI 1.2-1.9, p ≤ 0.001]). CONCLUSIONS: In contrast to many other regions worldwide, carbapenem resistance proportions among clinical A. baumannii complex isolates are relatively low in Germany and have declined in the last few years. Ongoing efforts in antibiotic stewardship and infection prevention and control are needed to prevent the spread of carbapenem-resistant A. baumannii complex in Germany.