Hygiene FAQs

Here you will find the most important facts about hospital hygiene in categories at a glance. We are constantly working on providing new information for you.

Health care-associated infections (HAI)


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What are hospital-acquired infections?

As the name implies, acquired infections are transmitted in hospitals or other healthcare facilities such as rehabilitation centres or nursing homes, where the patient’s immune system is weak and more sensitive to infections. HAI often occur in intensive care units. Therefore, they are also referred to as health care-associated infections (HCAI), because they do not only present themselves in hospitals.

One in 10 patients is infected with HAI. It is more common in developing countries, and more than 40% of hospital stays in Latin America and Asia lead to HAI. This is associated with costs and increased mortality.

How are H(C)AI transmitted? 

Infections can be acquired outside the healthcare facility, caused by other patients, nurses or even the patient’s own skin, if the microorganism breaks through the skin barrier. There are several ways to transmit HAI. For example, via laundry, air, contaminated equipment, personnel or – as mentioned above – the patient’s own skin.

The most common transmission is direct contact or droplets that change the host by talking or sneezing and coughing. Microorganisms transmitted by air are Legionella, Mycobacterium tuberculosis, Rubella and Varicella. They can travel long distances because they are carried by the air stream and then accidentally inhaled by another person. But there are also contact infections caused by equipment, apparatus or other people and by infectious food via the gastrointestinal tract. Insects can carry microorganisms, too.

How can H(C)AI be detected?

Symptoms vary from type to type, but usually a patient develops SSI, meningitis, pneumonia or urinary tract infections. HAI can also cause fever, shortness of breath, headaches, diarrhoea, nausea and leakage of wound secretion.

How are H(C)AI treated?

There are two infections that patients usually suffer from: Gram-positive strains of MRSA (methicillin-resistant Staphylococcus aureus) and gram-negative Acinetobacter baumannii. While MRSA is quite easy to treat, only a handful of effective antibiotics are available to treat Acinetobacter baumannii. In the worst case, infected persons have to be isolated in order to prevent further infection.

How can H(C)AI be prevented?

Irrespective of the type of infection, it is recommended to take QA/QC measures, continuously monitor air quality in the premises, hygiene protocols and guidelines for sterilization of instruments, hand hygiene, surface cleaning and the use of antibiotics, alcoholic rub-in preparations and hot water treatment. These steps can reduce the risk of HAI by 70%.

To cut a long story short: the answer is hospital hygiene.

Patients should be encouraged to inform staff of any complaints and symptoms. Staff and, in certain cases, visitors should also be encouraged to disinfect their hands properly.

Methicillin-resistant Staphylococcus aureus (MRSA)

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What is MRSA?

MRSA is the abbreviation for “methicillin-resistant Staphylococcus aureus”. MRSA germs thus count as staphylococci, a widespread group of bacteria. Like other staphylococci, MRSA is often found on the skin and mucous membranes of the upper respiratory tract of humans and animals. What is special about the MRSA germ is that many antibiotics do not have any effect on it – it is multi-resistant.

How is MRSA transmitted?

The pathogens are most frequently passed on from person to person by direct contact. The main transmission path are the hands. Both, MRSA patients and MRSA carriers can be vectors. The latter can also infect themselves if, for example, they transfer the bacterium from the nasal atrium into an open wound. Contact with contaminated objects such as door handles, handrails, handles or bathroom utensils may also result in infection. The pathogens adhere very well to plastic materials and stainless-steel alloys, such as catheters.

In recent years, commercial livestock farming has led to the development of a new source of MRSA infection for humans. Infections with LA-MRSA can occur in people who have direct contact with farm animals in mass livestock farming (especially pig and poultry fattening facilities). For example, farmers, veterinarians or slaughterhouse employees are affected.

How can an MRSA infection be detected?

If MRSA penetrates the tissue during an infection, the disease initially proceeds like an infection with “normal” staphylococci, i.e. it also shows the same symptoms: dermatitis (such as ulcers or pus accumulation), wound infections (especially after operations and inflammations of individual organs) such as urinary tract infections, pneumonia or bloodstream infections. Due to the existing antibiotic resistance, however, such MRSA infections (especially in septicaemia) are much more difficult to treat with medication, so that the disease can be life-threatening.

When does the disease break out and how long is a person contagious?

MRSA does not necessarily have to cause a disease. In people who are colonized with MRSA, a disease can break out when the immune system is weakened and the bacteria find their way into the body. The afflicted are contagious as long as the pathogen can be detected.

How long is the incubation period?

Approximately four to ten days after MRSA infection, the first symptoms appear. However, people who are not infected with MRSA, but only colonized, often do not experience any symptoms at all. In some cases, the germs simply live permanently on the skin and mucous membranes without causing harms.

How is an MRSA infection diagnosed?

For the tests, swabs are generally taken from the nasal atrium, pharynx, armpits and groin respectively pus or wound secretion from the infected tissue is collected. The testing also shows which antibiotic resistances are present in the MRSA germ. Such an antibiogram shows which medication is no longer effective against the pathogen and which is the most promising.

How are MRSAinfections treated?

In the case of an MRSA infection, the therapy usually consists of a special combination of different antibiotics. The threating physician selects exactly those antibiotics, that have been shown to be effective against the germ in the laboratory test (antibiogram), such as glycopeptide antibiotics together with rifampicin, clindamycin or gentamicin A combination of fosfomycin and fusidic acid is also possible. Drugs from the group of beta-lactam antibiotics are not suitable for therapy, because MRSA germs are resistant to them.

If the treating physician decides on MRSA therapy with only one single antibiotic, he or she can also resort to the active substance linezolid. Other drugs that can also be used in MRSA are tigecycline, daptomycin or newer cephalosporins.

How can MRSA infection be prevented?

Hospitals and care facilities can basically prevent the spread of MRSA easily by strictly adhering to certain hygiene measures: The spread of MRSA bacteria can be reduced by physicians and nurses through disinfecting their hands, disinfecting objects and wearing disposable gloves. Visitors should also use the hand disinfectants provided before and after each visit.

If an MRSA infection has been treated with antibiotics, this does not mean that the affected person is free of MRSA afterwards. As a rule, this is only the case if MRSA has also been remediated. After an MRSA infection has been treated, there is still often a colonisation with MRSA, but there are no symptoms. In this casefamily members or the immediate social environment do not have to worry about contracting MRSA. The risk of infection is very low for healthy people. Nonetheless, kissing or close physical contact can lead to temporary colonisation, which usually passes without symptoms.

However, people with open wounds or skin injuries should take precautions. This also applies to people who are generally susceptible to infections with staphylococci, such as people with chronic diseases (e.g. diabetes) or with a weakened immune system (e.g. after organ transplantation or due to HIV). In such cases, the treated MRSA patient should remain physically separated from others until complete MRSA remediation.

The approach in the Netherlands is partly different from that in other European hospitals. Since the 1980s, the so-called search-and-destroy-strategy has been pursued: every patient who might have MRSA is isolated and swabs are taken. Until it is clarified, the patient is treated in isolation. Swabs must also be taken from all contact patients. Patients or staff who appear to be positive for MRSA are treated with decontamination products. These are nasal ointments and chlorhexidine liquid soap, with which skin and hair have to be washed. If the MRSA bacteria also cause an infection, antibiotics are used. Physicians in the Netherlands are very cautious about employing antibiotics in order to avoid resistances. Due to the active search for MRSA, the screening strategy, and the moderate use of antibiotics, MRSA is relatively rare in the Netherlands compared to other countries.

Surgical Site Infections (SSI)

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What are surgical site infections?

A surgical site infection (SSI) is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material.

What are possible causes and risk factors of surgical site infections?

The most common germs causing SSIs are the bacteria Staphylococcus, Streptococcus, and Pseudomonas. Germs can infect a surgical wound through various forms of contact, such as from the touch of a contaminated person or surgical instrument, through germs in the air, or through germs that are already on or in the body and then spread into the wound.

How long after surgery is there a risk of infection?

A surgical wound infection can develop any time from two to three days after surgery until the wound has visibly healed (usually two to three weeks after the operation). Very occasionally, an infection can occur several months after an operation.

How are surgical site infections treated?

Most surgical site infections can be treated with antibiotics. The antibiotic depends on the bacteria causing the infection. Sometimes patients with SSIs also need another surgery to treat the infection.

Why should antibiotics be used before surgery, but not afterwards?

There is evidence showing that antibiotics given at a set time before surgery will usually prevent infections (prophylaxis). However, there is no evidence that using antibiotics for prophylaxis after surgery prevents infection in any way. In fact, it may even be harmful by contributing to the development of antibiotic resistance. Antibiotics should only be used after surgery to treat infections, not to prevent them.

How important is hand hygiene in the context of SSI prevention?

To prevent SSIs, doctors, nurses, and other healthcare providers should clean their hands and arms up to their elbows with an antiseptic agent just before the surgery and clean their hands with alcohol-based hand rub before and after caring for each patient.

What should patients consider before surgery?

Patients should ask the doctor what they can do to reduce their risk for a surgical site infection. The most important things are to stop smoking and to avoid shaving in the skin area that the surgeon is planning to operate through. The surgical team should be informed about the medical history, especially if the patient has diabetes or another chronic illness.

How can patients help to prevent a surgical site infection after surgery?

After surgery the patient should follow the doctor’s instructions about wound care. If the patient develops a fever or pus, redness, heat, pain or tenderness near the wound or any other signs or symptoms he/she should inform the doctor immediately.

Patients should make sure that doctors, nurses, friends and family members disinfect their hands before and after they enter the room.

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