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Infectiology

10.1.3. Nosocomial infections

Infections nosocomial According to Section 8 (8) IfSG, a nosocomial infection is “an infection with local or systemic signs of infection as a reaction to the presence of pathogens or their toxins, which is temporally related to an inpatient or outpatient medical measure, unless the infection has already occurred beforehand duration".

The time connection is essential for the definition of a nosocomial infection, less a causal connection with regard to a medical measure. Certain measures can lead to this (intensive therapy, immunosuppressive treatment, etc.)a.) that the risk of infections by pathogens with which they were previously colonized increases in patients.

These are so-called endogenous infections. The incubation period is suitable for differentiating between a nosocomial infection and an infection acquired on an outpatient basis. An example is the RSV infection. If a patient becomes symptomatic from the 5th day of their inpatient stay, a nosocomial infection can be assumed. Nosocomial infections can also manifest after discharge.

Prevention of nosocomial infections

The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the RKI has formulated recommendations for the prevention of nosocomial infections as well as for operational-organizational and structural-functional hygiene measures in hospitals and other medical facilities (Section 23 (1) IfSG). The measures include:

  • • Identification of patient-related Risk factors for nosocomial infections: risk factors emanating from the patient are e.g.B. congenital or acquired immune defects, immunosuppressive therapy, impaired barrier function of the skin and mucous membranes (e.B. after operations), in premature babies with a birth weight <1,500g, after burns and scalds. The use of foreign bodies (catheters, gastrostomies, shunts, invasive ventilation, etc.)a.) increases the risk of nosocomial infection as does the long-term use of anti-infectives.
  • Personnel requirements: Hygiene specialists should be available in sufficient numbers in a clinic and regularly present on the wards. The hygiene specialists work closely with the hospital hygienist, microbiology and virology. Timely communication of microbiological or virological findings, if necessary targeted colonization screening to detect colonization with certain multi-resistant pathogens, as well as close cooperation with "Antibiotic Stewardship Teams" (ABS) and ABS-authorized doctors are essential elements for preventing nosocomial infections .
  • Structural and organizational requirements: This includes a department-specific hygiene plan, hygiene data sheets, standard operating instructions (SOPs) for hygiene-relevant work processes, defined concepts for induction, training and practical training of new employees with regard to the standards of infection prevention, the availability of dispensers for hand disinfection, the provision of the necessary protective clothing and many more further measures.
  • Structural and functional requirements to isolate any contagious patients must be available in sufficient numbers and appropriately equipped.
  • • For patients with a particular risk (oncology, cystic fibrosis, etc.)a.) It must be ensured that there is no pathogen exposure from the Drinking water comes (e.g.B. Legionella, Pseudomonas aeruginosa, atypical mycobacteria and the likea.).
  • Measures in basic hygiene: Basic hygiene measures (formerly: standard hygiene) are carried out with every contact with the patient and his environment, so that the transmission of infectious agents to patients or staff is prevented. The basic measures include, in particular, hand disinfection, the targeted use of virucidal hand disinfectants and the use of personal protective equipment when handling blood, body fluids, excreta and secretions; Measures of Contact isolation, aseptic procedure in all invasive measures and in the maintenance of catheters, drains, etc., aseptic procedure in the reconstitution of drugs and the preparation of mixed infusions as well as safe injection and infusion practice. The basic hygiene measures should be worked out and discussed in detail with the hygiene specialists for the respective areas.
  • Personal protection orientation: This includes mouth and nose protection (MNS), which, depending on the pathogen, should be used as particle filtering half masks (FFB). Further items of equipment are medical disposable gloves and disposable gowns. It must be emphasized that all measures are subordinate to the individual careful hand disinfection and must not be thwarted by a pseudo-security.

Surveillance of nosocomial infections (NI)

The monitoring of nosocomial infections includes the recording of events according to uniform definitions with standardized methods as well as the analysis of the results by means of size incidence density (NI per 1,000 patient days) or incidence rate (NI per 1,000 application days, e.g.B. of central vascular catheters). The results must be reported back to the treatment team.

Clinics for children and adolescents should have one Visitor regulation which on the one hand ensures the medical and psychosocial reasons for the presence of confidants in the hospital, but on the other hand protects patients, relatives and employees or ensures that certain infections such asB. varicella, measles, RSV or influenza are not entered into the clinic.

Important information can be found at: