Experts suspect negligence due to excessive demands: more clinical infections despite corona hygiene – politics

The number of infections that patients get through treatment in German clinics has not decreased despite stricter hygiene requirements during the corona pandemic. On the contrary: it has increased even further. That goes from the new Barmer hospital report which was presented in Berlin. By the end of 2020 there were around 34,000 additional infected people across Germany and up to 1,300 further deaths due to so-called nosocomial infections, many of them caused by multi-resistant germs.

The chief executive of the health insurance company, Christoph Straub, has two explanations for the development, which is surprising at first glance. On the one hand, during the first wave in particular, fewer light cases and significantly more elderly and seriously ill people who were more susceptible to infections were on the wards, he said. In addition, there is the high workload for the clinic staff, who sometimes also lacked protective equipment at the beginning of the pandemic.

Rapid growth of over a fifth

“During the corona pandemic, the hospital staff was apparently so stressed that they could not always fully comply with the high hygiene standards required,” said Boris, the co-author of the report and head of the “Health” competence area at the RWI Leibniz Institute for Economic Research in Essen Augurzky. This is “an extremely important aspect, especially in times of pandemics, which can make the difference between life and death”.

According to the study, between 2017 and 2019, an average of around 5.6 percent of hospital cases were diagnosed with a nosocomial infection. This is evident from a sample of five million cases. Immediately at the beginning of the pandemic, this value rose to 6.8 percent, which corresponds to an increase of over a fifth within a few weeks. The quota remained at more than six percent for the rest of the year.

“Indirect side effect of the pandemic”

During the investigation, the four-person team of authors took great care not to “compare apples with pears,” emphasized Augurzky. In fact, the number of hospital patients in the first phase of the pandemic fell by up to 46 percent. At this time, primarily more severe cases with a higher risk of infection were treated. But even if the changed patient structure is taken into account separately through adjustments, there is an increase in the incidence of infections of almost ten percent in the first and 17.5 percent in the second wave by the end of 2020. Everything has to be done, and not just from the patient’s point of view to prevent these infections, the hospital expert said. The treatment of the infected is also extremely expensive for the insured community, with additional costs of around 1.5 billion euros annually.

“The increased likelihood of acquiring a nosocomial infection appears to be an indirect and undesirable side effect of the pandemic,” summarized Augurzky. However, even without corona, around 400,000 to 600,000 patients fell ill annually in Germany with a hospital infection, and in 10,000 to 15,000 cases these were fatal. From the point of view of the researchers, around 30 percent of these infections could be prevented with suitable prevention.

Due to the ongoing explosiveness, the subject of hospital hygiene must become “a national health goal”, demanded treasurer Straub. After all, billions are invested in reducing the number of road accidents, he argued. “We need a master plan and concerted action.” And first and foremost, better data and an evaluation of previous measures are required.

Cashier demands unannounced hygiene checks

Specifically, one needs more examination of clinical hygiene in the training of doctors and nurses, said Straub. Such knowledge then has to be “deepened in everyday working life and become a daily routine”. This requires reliable procedures and trained employees who can monitor compliance with hygiene standards and develop them further if necessary. Hygiene specialists are already being deployed in the hospitals. “However, the acceptance and work of these specialists must be strengthened in everyday work so that in exceptional situations such as a pandemic, higher hygiene requirements do not lead to stressful situations.”

In addition, it is important to create more transparency about nosocomial infections in hospitals. The corresponding laboratory results have not yet been included in the billing data of the health insurance companies, criticized Straub. As a result, the infections acquired in the hospital can currently only be roughly determined. In future, these infections will need to be “clearly mapped” in the classification system for medical diagnoses, the so-called ICD catalog. In addition, their coding must be made mandatory in the settlement with the cash registers. From the point of view of the treasurer, it should “differentiate between the type of pathogen and whether the infection occurred before or during a hospital stay”. This allows valuable conclusions to be drawn as to where hygiene measures need to be improved.

However, compliance with the hygiene standards should not only be checked internally, but also by the public health service more intensely than before and also unannounced, urged Straub. If defects remain a matter of interpretation and can only be criticized but not made public, controls are also “toothless tigers”. Therefore, the Federal Joint Committee (G-BA) should develop a guideline with binding minimum requirements with the Robert Koch Institute (RKI). The clinics would then have to publish compliance with these requirements in their quality reports.

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