EH 2_2015

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Take control of your connectivity Hematology ekfdiagnostics.com Source:Shutterstock/CASTALDOstudio.com www.healthcare-in-europe.com 15LABORATORY Nosocomial infections kill 50,000 European patients annually Microbes vs. viruses Hand Report: Walter Depner In European acute care hospitals, on any given day, an estimated 80,000 patients – roughly six percent of all patients – receive antimicrobial treatment to fight a healthcare asso- ciated infection (HAI), according to the European Centre for Disease Prevention and Control (ECDC). 3.2 million victims a year Between 2011 and 2012, the ECDC surveyed 1,000 hospitals with more than 231,000 patients from all EU Member States, plus Norway and Iceland. The results indicate that approximately 3.2 million patients acquire a nosocomial infection every year in the EU. The high- est infection rates are reported in Portugal (11%), Greece and Spain (9% each). Germany, with its infec- tion rate of 5%, ranks slightly below the EU average. In the United Kingdom the infection rate is almost 9% (England 8.2%, Wales 6.4%, Scotland 9.5% and Northern Ireland 5.4%). In France there are no reliable recent data, but experts discuss a prevalence of 3- 6%. The same is true for Austria, where the percentages are considered to be roughly the same as in Germany. According to the study, in Europe around 50,000 patients die from HAI every year – a figure, the ECDC underlines, which has to be used with caution due to differences in reporting procedures and incom- parable or incomplete data. As in many comparisons and surveys of this kind the number of unreported cases might be considerable. As far as Germany is concerned, the ECDC study estimates 400,000 to 600,000 new HAI cases per year and 15,000 deaths. However, during the German Congress for Hospital Hygiene in Berlin in March 2014, the German Society for Hospital Hygiene said it considers the ECDC figures to be ‘doctored’: According to the Society’s estimates, in 2012 up to 900,000 people acquired HAI and up to 40,000 patients died from a nosocomial infection. Last, but not the least, in the USA data (most likely from 2006, the exact time frame of the survey is unclear) roughly 1.7 million HAIs were estimated (infection rate of 5.9%) to have caused or contrib- uted to almost 100,000 deaths. More recent data indicate that infection rates are stable. In the meantime, the ECDC has developed a unified European protocol for so-called point preva- lence studies (PPS) and urged all European countries as of 2011/2012 to conduct national PPS on HAI and antimicrobial use. (Bemke, M. et al, Deutsche Ärzteblatt 110 (38) September. 2013) Another important issue has been making headline for about a year: Ebola, above all spreading in West African countries – Sierra Leone, Liberia and Guinea. The figures are frightening – more than 8,200 people have died and about 25,000 people are infected with the Ebola virus. The number of unreported or undetected Ebola-caused deaths is most likely even more significant than the number of unreported or undetected HAI-caused deaths in Europe. Fortunately there are worldwide initiatives, research and support projects, fund raising campaigns, emergency hospitals and volunteers to help contain the pandemic. In March 2015 a large-scale vaccination campaign was launched with more than 10,000 participants. While the campaign’s success is impossible to predict, it will raise many ques- tions – particularly if successful: How quickly can pharmaceutical companies produce and distribute the vaccine? How can an uninter- rupted cold chain be ensured dur- ing transport and storage? How can the necessary infrastructure be established? These are enormous challenges with uncertain results. In Germany, the Robert Koch Institute (RKI) and other healthcare groups drafted ‘Recommendations and Information’ and established STAKOB, a network of competence and treatment centres in charge of infection control and of clinical Ebola management, which provide trained staff, specialised diagnostic equipment and dedicated wards. While there are no reliable figures on the financial and other resources being used in Europe and across the world for Ebola research, treat- ment, aid, infrastructure, etc. we are no doubt talking about billions of euros – and no one knows whether these funds are sufficient, insuf- ficient or too much, or whether they are being invested in useful or superfluous projects. HAI numbers differ widely By no means do I want to create the impression that I am support- ing a pro/con microbes or viruses – or vice versa – stance. Quite the contrary: I do want to underline the need to fight microbes and viruses with the same sense of urgency. Rather than comparing or offsetting 50,000 deaths in Europe with 8,200, or whatever number of deaths in Africa, we must treat both issues urgently, efficiently and intelligently. Having said that, I do think we need to ask troubling questions, such as why, in Europe with its more or less comparable health- care standards, does the prevalence of nosocomial infections differs so widely – at between 5-11%. It is indisputable, however, that the efforts must not be influenced by media coverage or public atten- tion. Every death due to a nosoco- mial infection, or Ebola, whether in a state-of-the-art ward, a European metropolis or an African camp, is one death too many. reports. In developed countries the risk of healthcare associated infec- tions is twenty times as high. ‘An awareness campaign on its own is not enough. The key to suc- cess lies in the adoption of the entire strategy,’ Pittet emphasises. This is what he tried to explain to every- one who, over the years, has asked for permission to use the cartoons displayed at Geneva’s University Hospital. Regular self-assessment is essential to help achieve sustainable changes in behaviour. Hand hygiene is only one aspect of efforts to defeat nosocomial infections. ‘Antibiotics management is just as important,’ emphasises Prof. Herman Goossens MD, head of the Department for Microbiology at Antwerp University Hospital. There is a clear connec- tion. ‘The more antibiotics pre- scribed, the more resistance occurs.’ Hospitals are particularly prone to resistant pathogens. At the First CEE Conference on Hospital Hygiene and Patient Safety, Goossens report- ed on a campaign in Belgium that was introduced to reduce the high prescription rates for antibiotics. This included advertisements on posters, in newspapers, on radio and television as well as information brochures and a website. The key point was a metaphor describing antibiotics as swimming armbands, worn daily on buses or in streets, but which deflate as soon as the wearer actually falls in the water. The success: Around €500 million were saved between 1999 and 2010 because the prescription rate for antibiotics was reduced. +49 (0)392037850.

EH 2_2015

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