Transparency of infection numbers: Would cause a certain positive pressure but could foster defensive medicine. With Dr. Agnes Wechsler-Fördös from the antibiotics and infection control unit of the hospital Rudolfstiftung Vienna, spoke Carola Timmel.
In connection with Infection Control and Antibiotic Stewardship the call for greater transparency can be heard again and again. Only few hospitals disclose their infection numbers. From the perspective of the hospitals this is understandable. On the other hand – wouldn’t transparency cause a certain positive pressure?
This is a very delicate question – yes and no. Transparency cannot be considered as completely harmless. It increases the risk that hospitals get under pressure to communicate false numbers especially if negative consequences could apply. Furthermore, it could foster defensive medicine. Moreover, people see the numbers without an appropriate context, and therefore misinterpretations may arise. But internally and among hospitals the figures should be disclosed. Let’s take the infection system KISS as an example. The main principles of KISS are the voluntary participation and the confidential handling with the results. In such a way it is possible for the hospitals to compare their own infection data with reference data of comparable stations. This is a good trigger, a positive competition.
What’s about the figures in the field of the hygiene personnel? It is repeatedly pointed out that the ratio between patient and hygiene specialist is not coherent.
In the 1970s studies have been conducted in the United States to find out what personnel structures are needed in hospital hygiene. At least a ratio of one infection control nurse for 250 beds was the result. This was a minimum requirement, and a kind of international benchmark was created.
For some years now, one can observe a positive development in France and England. Due to the pressure on the hospitals to provide more hygiene personnel, MRSA and Clostridium difficile rates fell significantly. A well-known French publication from 2009 shows how important it is to provide appropriate structures. The recommendations therein contained are very helpful (French National Program for Prevention of Healthcare-Associated Infections and Antimicrobial Resistance, 1992-2008: Positive Trends, But Perseverance Needed; in: Infection Control & Hospital Epidemiology / Volume 30).
What’s about the creation of Antibiotic Stewardship programs?
An Antibiotic Stewardship program is an important component in the fight against healthcare associated infections. Among other interventions, we have to convince healthcare personnel that detection of bacteria in clinical samples is not necessarily an indication for antibiotic therapy. This might sound banal, but in practice, it often comes to incorrect medical description. What we really need is a series of rapid tests, possibly also as point.of-care tests. For example an area-wide rapid test for children with angina would be desirable. In our hospital we make rapid testing for influenza in flu times because we want to avoid unnecessary antibiotic prescriptions for flu patients. In the Southwest of France they are very advanced: In 85 percent of the hospitals there is a counselling centre for questions about antibiotics. Some prescriptions can only be made after consultation with an expert.
Our goal must be the legal anchoring of ABS like in Germany through the Infection Protection Law. In Slovenia for example the legal basis for ABS has already been implemented, and in the Netherlands this measure is in preparation.
Ignaz Semmelweis is known as the father of infection control. What can we learn from him in the implementation of the urgently needed structures?
He was known for his perseverance. Also we hygienists nowadays are often confronted with resistances. I think, the secret lies in communication. It takes an enormous amount of psychological knowledge to convey important messages in hygiene. Worth mentioning in this context is a project called PSYGIENE. The research-team under the lead of Prof. Iris Chaberny, Medical University of Leipzig wants to find out which obstacles prevent that existing hygiene-knowledge is implemented and then tackle these hurdles appropriately. Projects such as this are extremely important for the future of hygiene and the safety of our patients.
