Hospital Hygiene and Infectiology
Having high competence in the fields of infectiology and hospital hygiene (both areas closely linked) is more important than ever today. The increasing number of infections, alongside the rise in detection of multi-resistant pathogens, makes it necessary to prevent infections and, when needed, initiate the correct antibiotic therapy. This therapy must be effective quickly and should avoid the development or selection of resistant microbes.
Hospital hygiene aims to protect patients from nosocomial infections. An infection is considered nosocomial if it occurs from the third day of hospital stay, meaning the infection was acquired in the hospital. However, it is important to distinguish where the pathogens originate.
There are fundamentally two ways infections can occur:
1. Microorganisms originating from and brought in by the patient themselves.
2. Pathogens transmitted from outside to the patient.
We are all inhabited by trillions of microorganisms that colonize the skin, upper respiratory tract, urogenital tract, and especially the gut, which has the highest microbial load in the colon. This natural process benefits humans in many ways. However, if bacteria from the natural human flora enter a surgical wound, the urinary tract post-operation, or the lungs, these microbes can sometimes cause severe, even life-threatening infections (endogenous infections).
The second infection possibility involves pathogenic bacteria transmitted from outside to the patient. These pathogens can be transferred, for example, from patient to patient via healthcare workers' hands or originate from the environment of the patient’s room (exogenous infections). Hospital hygiene measures therefore focus on two points: the patient’s environment and the patient themselves. Through consistent and organizational measures, the risk of transmission from patient to patient is minimized.
Hospital Hygiene at St. Wolfgang
All rooms are cleaned and disinfected according to the latest guidelines from the Hospital Hygiene Commission, and all staff are regularly trained by our hygiene specialists on patient handling. One of the most crucial measures is hygienic hand disinfection. The second focus is on the patients themselves. For example, if there are indications or risk factors suggesting that a patient may already be colonized with multi-resistant pathogens upon admission to the Clinic St. Wolfgang, microbiological screening is performed. When patients are admitted for surgery, preoperative care, especially of the surgical site, is essential to prevent postoperative wound infections. The same applies to postoperative care. Clear procedures are outlined in the hygiene plan for these cases, based on international scientific findings and guidelines.
In the rare event that nosocomial infections occur, additional measures from the hygiene plan are immediately implemented. The hygiene plan of St. Wolfgang is stored electronically and accessible to every staff member at all computer terminals. The focus is not only on the up-to-date and high-quality content but also on easy and quick access for questions or issues. All nosocomial infections—such as pneumonia, postoperative wound infections, urinary tract infections, infections of bones and joints, and antibiotic-associated diarrhea—are recorded with a specially developed innovative program and regularly analyzed. This allows us to identify and address potential deficiencies or gaps in patient care over time: danger recognized, danger contained!
Between January 2017 and September 2018, a total of 7 postoperative wound infections (5 superficial, 2 deep) with an incidence of 0.5%, 3 clinically defined pneumonias with an incidence of 0.26%, 2 urinary tract infections (0.17%), and 1 case of antibiotic-associated diarrhea occurred. These low numbers demonstrate the effectiveness of the hospital hygiene measures and responsible antibiotic use.
All resistant pathogens detected during this period (3MRGN), including one MRSA strain (community-acquired: CA-MRSA), were brought in by the patients. No transmission to other patients occurred.
If a patient already has an infection upon admission to St. Wolfgang Hospital or develops a treatable bacterial infection during their stay, then the correct empiric antibiotic therapy is of crucial importance even before the results of microbiological testing are available.
There are several factors to consider when selecting the appropriate antibiotic:
- Location of the infection
- Severity and course of the illness
- Possible source of the pathogen
- Condition after surgery
- Age
- Underlying diseases
- Immune status
- Previous hospital stays, for example, with evidence of resistant pathogens or medical procedures
- Possible side effects of the antibiotic
- Travel history / origin
In these cases, the therapeutic decisions made by the doctors at St. Wolfgang are based on national and international guidelines, as well as on many years of personal experience in dealing with critically ill patients. As with hospital hygiene, the selection of the right antibiotic is supported by a specially developed program available to the physicians. All treatments are documented electronically and periodically evaluated to identify trends and potential errors.