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ECR 20 EH@ECR Currently there is a truly enormous hole in the ground in the city of Wiener Neustadt, Austria, but by summer 2012 MedAustron, one of the most modern centres for ion therapy and research in Europe, is to be built here. After two treatment centres in Germany failed, gaining from the experience and failure in others, this €200 million MedAustron project will be one of four ion therapy centres worldwide to offer treatment with protons as well as carbon ions Ion therapy is considered a great beacon of hope in cancer care – especially for tumours with no hope for a around 70,000 have received ions. This inclu protons as we ‘This therapy is ferent from co radiotherapy a by increased, effectiveness,’ e Ramona Maye MedAustron. ‘T of the ray allow geted applicatio certain tumour slow-growing, tumours, or tum imity to radiati will particularl procedure whic plement to che gery in these ca The ions hav to up to 70% o with the help of tor. Financed by Austria, the sta and the City o the MedAustron on 50 years of by the Europ for Nuclear Re Geneva, Switz Institute for Par wide, for the its own accele ‘The accelerat will basically world’s largest tor, the LHC, u big bang expe explained Dr Managing Direc ‘The design wh the so-called P Machine Study on a synchrotro erator with a around 80m, wh particles to high 40 MedAustr spent several CERN on the Belg Ever grow cancer th Around half a do gigantic cyclotro therapy, yet ove technology. The of the working p has also installe Prague, Paris (O East, three of its Korea and one in In late Novem showing a signif same period in 2 performance in i systems sold in t financial quarter an ultra-compac This first insta solution will be in Shreveport. In January 20 diagnosis and Applications S Olivier Legrain became Chief succession to CEO Pierre Mo Board – prior Such neat pla typify the inte 2,100 professi diagnostics an specialist firm EUROPEAN HOSPITAL Publisher, Theodor-Althoff-Str. 45, 45133 Essen, Germany Phone: +49 (0)201 87 126 850 Fax: +49 (0)201 87 126 864 E-mail: info@european-hospital.com Editor-in-Chief Brenda Marsh Art Director Mary Pargeter Managing Editor Brigitte Dinkloh Editor Karoline Laarmann Production & Distribution Janka Hoppe Russian Supplement Sergey Bezrukov, Fibrotex GmbH, Fischerstr. 1, 40477 Düsseldorf Phone: +49 211 550 49 70, E-mail: ﬁbrotex@gmx.net Executive Director Daniela Zimmermann Founded by Heinz-Jürgen Witzke Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. France: Annick Chapoy, Jane MacDougall. Germany: Anja Behringer, Annette Bus, Bettina Döbereiner, Karl Eberius, Guido Gebhardt, Walter Schäfer, Susanne Werner, Holger Zorn. Great Britain: Brenda Marsh, Mark Nicholls. Malta: Moira Mizzi. Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya, Alla Astachova. Spain: Eduardo de la Sota. Switzerland: Barbara Steinberg, Dr. André Weissen. USA: Kerry Heacox, i.t. Communications. UK editorial address 55 Wey Meadows, Weybridge, Surrey KT13 8XY Subscriptions Janka Hoppe, European Hospital, Theodor-Althoff-Str. 45, 45133 Essen, Germany Subscription rate 6 issues: 42 Euro, Single copy: 7 Euro. Send order and cheque to: European Hospital Subscription Dept Printed by Frotscher Druck Darmstadt, Germany Publication frequency bi-monthly European Hospital ISSN 0942-9085 Representatives China & Hongkong: Gavin Hua, Sun China Media Co., Ltd, Room 802, 15th Building, BinJiang Residential Quarter, Dongyuan Road, Futian District, Shenzhen, Guangdong, China, Code: 518031 Phone: +86-0755-81 324 036 E-mail: gh@european-hospital.com Germany, Austria, Switzerland: Ralf Mateblowski Hintergasse 1, 55234 Hangen-Weisheim, Germany Phone: +49 6735 912 993 E-mail: rm@european-hospital.com France, Italy, Spain: Eric Jund, 2264 Chemin de Sainte Colombe, 06140 Vence, France Phone: +33 493 58 77 43 E-mail: ej@european-hospital.com GB, Scandinavia, BeNeLux: Simon Kramer, Willem Alexander Plantsoen 25, 2991 NA Barendrecht Phone:/Fax +31 180 6200 20 E-mail: sk@european-hospital.com Israel: Hannah Wizer, International Media Dep. of El-Ron Adv. & PR Co., Ltd., 7, Leteris street, Tel-Aviv 64166, Israel Phone: +972-3-6 955 367 E-mail: hw@european-hospital.com South Korea: CH Park, Far East Marketing Inc, Room 103-1011, Brown Stone, 1330, Baekseok-dong, Ilsan-ku, Goyang-si, Gyunggi-do, Korea 410-360 Phone: +82 2 730 1234 E-mail: ch@european-hospital.com USA & Canada: Hanna Politis, Media International, 8508 Plum Creek Drive, Gaitherburg, MD 20882, USA Phone: +1 301 86 96 610 E-mail: hp@european-hospital.com EUROPEAN HOSPITAL www.european-hospital.com www.european-hospital.com INFECTION CONTROL Aspiration and infection Immune marker identifies children’s nosocomial infection risk Interview Ralf Mateblowski Professor Tobias Welte MD, President of the 24th International Congress of the European Respiratory Society, gave EH some personal views on the symposium ‘New perspectives in the management of nosocomial pneu- monia’ ‘A load of nonsense!’ Such was the professor’s spontaneous response to calls for complete avoidance of noso- comial infections. ‘You always have to differentiate between nosocomial infections that are acquired and those which come from patients them- selves,’ he explained. ‘When patients suffering chronic colonisation with nosocomial pathogens in the bowel have to undergo abdominal surgery then infections sometimes simply cannot be avoided - and the major- ity of all infections are based on this endogenous, intrinsic mechanism. It is therefore an illusion to believe nosocomial infections can be entirely avoided. On the contrary: The major- ity cannot be avoided!’ Nevertheless, there are noteworthy successes in prevention. ‘For a long time the focus was on MRSA; ten years ago we had an increasing prev- alence in Germany of 22-25%. Since then, we have seen a slight drop to currently around 17-20% because of Clinical scientists at Nationwide Children’s Hospital in Columbus, Ohio, have identified an immune marker that predicts the risk of a paediatric patient developing a nosocomial infection. Physicians can more closely monitor these highly susceptible patients and more rap- idly perform immune function tests. Immune system impairment is measurable and characterised by a reduced ability of whole blood to produce the pro-inflammatory cytokine tumour necrosis factor alpha (TNF-alpha) that fights infec- tion. Lower TNF-alpha production capacity has also been associated with adverse outcomes for children with influenza, cardiopulmonary bypass, and organ dysfunction syn- drome. Principal investigator Dr Mark W Hall, chief of the critical care medi- cine division and director of the Immune Surveillance Laboratory, and colleagues, have spent more than a decade studying the immune systems of critically ill children, including collaborative work with Dr Hans-Dieter Volk of the Department of Medical Immunology at Charité University Medicine Berlin. Their most recent study (pub. online 21/6/2014 in Shock) ana- lysed the immune systems of 21 healthy children and 76 critically injured children admitted to the PICU. Sixteen critically injured patients (21%) developed nosoco- more standardised infection preven- tion and control procedures. A further decrease is possible, but it would be an illusion to believe that the figure can be cut to below 10%.’ The main reason for this is that staphylococcus bacteria are different from other pathogens in their biology and disease mechanisms. ‘Resistant coli, for instance, are almost never transmitted via the hands but, in the case of staphylococcus, hand hygiene is the key issue! The clean hands campaign, supported by the Federal Ministry of Health, was very success- ful. Standards were developed for many procedures where staphylococ- cal infections play a part, such as for inserting catheters. It’s all the more incomprehensi- ble then that the coordinating man- ager of the national reference cen- tre, Professor Gastmeier, is currently having to look for private sponsors because the federal government no longer finances this campaign!’ The symposium in Munich also featured discussions about HAP (hos- pital acquired pneumonia) and the American programme ‘zero VAP’, aimed at reducing the number of ven- tilator associated pneumonia cases to zero. Says Welte: ‘The Americans have now realised that this measure is absurd: with a patho-mechanism that mial infections within 14 days of admission. All had lower TNF-alpha production capability (< 520 pg/ ml compared to a median 1297 pg/ ml measured in the healthy control group). Half the patients also received at least one red blood cell transfusion. The researchers also discovered that children who had a transfusion with blood stored for more than two weeks demonstrated a lower level of TNF-alpha production than children who received blood stored for 1-13 days. Potentially, this find- ing could change blood selection for transfusions in patients identi- causes such complex cases of pneu- monia you can only influence some individual factors, but not patient- inherent ones. As yet, there are no significant procedures for this.’ A lot has been invested over the last few years to accelerate infection diagnosis. This has two major impli- cations, says the pulmonologist: ‘The classic, microbiological diagnosis has become much faster; resistant patho- gens can now be isolated and identi- fied in just a day. Additionally, modern PCR sys- tems help to gain another few hours. However, the disadvantage is that these staff and equipment intensive procedures are based on amplifica- tion, meaning they can only detect what is coded on the chip. ‘That’s easier for gram-positive pathogens with their fairly preserved, standard resistance mechanisms, than for gram-negative pathogens, where we basically observe new resistance mechanisms emerge almost every week. In my view it will be hard for PCR procedures to become estab- lished in the hospital. There also will be no way around classic microbiol- ogy in the future.’ Could the rise in resistances be con- tained? Welte is optimistic: ‘Thankfully there is finally a little more happen- ing with regards to the development fied at high risk for infection. ‘It’s not yet clear if blood transfusions are immunosuppressive, but our work so far suggests that blood may become more immunosuppressive the longer it sits on a shelf,’ Dr Hall explained. Currently, ABC PICU, an international clinical trial being con- ducted by the other investigators comparing the clinical consequenc- es of red blood cell storage duration (NCT01977547), is recruiting paedi- atric patients to determine if fresher blood will help improve outcomes. Additionally, Dr Oliver Karam, attending physician at Geneva University Hospital’s neonatal and of new substances. At the beginning of October a new cephalosporin* was introduced to the German market that’s also effective against MRSA. Some other substances are also cur- rently going through the licensing procedures, so we should be able to move on from the very low point – i.e. 10 years without new antibiotics. ‘However, the problem remains that the development of resistances occurs much faster than that of the new sub- stances. Too many factors come into play here, including the misuse of antibiotics itself, their widespread use in mass farming and the globalisation of resistances through tourism. ‘Ultimately, the much-needed sup- port from politicians is not forthcom- ing: All (preventative) measures are labour-intensive. In high-risk areas, such as intensive care units, the staff cover in many places is already insuf- ficient. If staff numbers keep being reduced further for economic reasons all well-meant infection prevention and control programmes will be of no benefit – and incidentally, neither are standards and guidelines imple- mented on their own, without repeti- tive teaching and monitoring!’ * A group of broad-spectrum antibiotics that prevent the rebuilding of the cell walls in bacteria that divide and therefore have a bactericidal effect. Penicillin falls within this group. paediatric critical care unit, heads a clinical trial that started in April 2014 to assess the effect of plasma transfusions on critically ill chil- dren. This international initiative has enrolled more than 100 hospi- tals in 22 countries, and will be the largest paediatric study on trans- fusion medicine ever undertaken, Dr Karam told European Hospital. Patients are still being recruited, with information at http://www.plas- matransfusion.org/’www.plasma- transfusion.org. These are among several activities of members of the Paediatric Critical Care Blood Research Network (http://www.bloodnetresearch.org www.bloodnetresearch.org), a coa- lition of predominantly Canadian and U.S. researchers, but which is intended to have a global reach. ‘Continuing research is so impor- tant,’ Dr Hall stressed. ‘Paediatric hospitals have made headway in reducing preventable infections; but what we learned from our study is that it’s important to consider each individual patient’s immune system and how well the patient can fight off infection. We believe that critical illness- and injury-related immune suppression may be reversible and help our patients recover more rap- idly.’ Zero percent and other illusions New for paediatric intensive care The majority of nosocomial infections cannot be avoided The Nationwide Children’s hospital in Columbus, Ohio Tobias Welte MD is a specialist in internal medicine, pulmonology, critical care and infectology. Early on in his career he was a house officer and registrar in Lehrte and Hanover, before spending a decade as head of the Pulmonology and Critical Care Medicine Division, at Otto- von-Guericke University, Magdeburg. The professor has directed the Department of Pulmonology at Hannover Medical School since 2004 and is the current president of the German Respiratory Society. Critically ill children hospitalised with traumatic injuries have a high risk of acquiring noso- comial infections, especially if their immune function is impaired. A nosocomial infection, such as sepsis, can become as deadly as a traumatic injury, the leading cause of death in chil- dren. Nosocomial infections also contribute to longer stays in paediatric intensive care units (PICU) and thousands more in medical costs, Cynthia E Keen reports Paediatrician Mark W Hall MD heads the Immune Surveillance Laboratory, Columbus, Ohio Editor-in-Chief: Brenda Marsh Art Director: Olaf Skrober Managing Editor: Chrissanthi Nikolakudi Editor: Brigitte Dinkloh Senior Writer: John Brosky Executive Director: Daniela Zimmermann Founded by Heinz-Jürgen Witzke Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. France: Annick Chapoy, Jane MacDougall.Germany: Anja Behringer, Annette Bus, Bettina Döbereiner, Matthias Simon, Axel Viola, Cornelia Wels-Maug, Susanne Werner, Holger Zorn. Great Britain: Brenda Marsh, Mark Nicholls. Malta: Moira Mizzi. Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya, Alla Astachova. Spain: Eduardo de la Sota. Switzerland: Dr. André Weissen. USA: Cynthia E. Keen, i.t. Communications, Jacquie Michels Subscriptions Janka Hoppe, European Hospital, Theodor-Althoff-Str. 45, 45133 Essen, Germany Subscription rate 6 issues: 42 Euro, Single copy: 7 Euro. Send order and cheque to: European Hospital Subscription Dept Printed by: Margreff Druck, Essen, Germany Publication frequency: bi-monthly European Hospital ISSN 0942-9085 Representatives China & Hongkong: Gavin Hua, Sun China Media Co, Ltd, Room 802, 15th Building, BinJiang Residential Quarter, Dongyuan Road, Futian District, Shenzhen, Guangdong, China, Code: 518031 Phone: +86-0755-81 324 036 E-Mail: gh@european-hospital.com Germany, Austria, Switzerland: Ralf Mateblowski, Hintergasse 1, 55234 Hangen- Weisheim, Germany Phone: +49 6735 912 993 E-Mail: rm@european-hospital.com France, Italy, Spain: Eric Jund, 2264 Chemin de Sainte Colombe, 06140 Vence, France Phone: +33 493 58 77 43 E-Mail: ej@european-hospital.com GB, Scandinavia, BeNeLux: Simon Kramer, Willem Alexander Plantsoen 25, 2991 NA Barendrecht, The Netherlands Phone/Fax: +31 180 6200 20 E-Mail: sk@european-hospital.com Israel: Hannah Wizer, International Media Dep. of El-Ron Adv. & PR Co., Ltd., 7, Leteris street, Tel-Aviv 64166, Israel Phone: +972-3-6 955 367 E-Mail: hw@european-hospital.com South Korea: CH Park, MCI, Room 103-1011, Brown Stone, 1330, Baekseok-dong, Ilsan-Ku, Goyang-si, Gyunggi-do, Korea 410-360 Phone: +82 2 730 1234 E-Mail: chp@european-hospital.com USA & Canada: Hanna Politis, Media International, 8508 Plum Creek Drive, Gaitherburg, MD 20882, USA Tel: +1 301 869 66 10 E-Mail: hp@european-hospital.com 23 Phone: +49 (0)20187126850 Fax: +49 (0)20187126864 Phone: +492115504970, Phone: +86-0755-81324036 Phone: +496735912993 Phone: +33493587743 Phone:/Fax +31180620020 Phone: +972-3-6955367 Phone: +8227301234 Phone: +13018696610 Phone: +86-0755-81324036 Phone: +496735912993 +33493587743 Phone/Fax: +31180620020 Phone: +972-3-6955367 Phone: +8227301234 Tel: +13018696610

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