Hygiene in sharp focus

15th of September 2010

Hygiene in healthcare has become a focus for public attention in Germany, says Thomas Schulte-Marxloh.

On Friday August 20 11 infusions were prepared in the pharmacy department of the Mainzer Universitätsklinik which were applied to babies and premature infants in the hospital. Two of the babies died on Saturday, a premature infant died two days later. On Saturday afternoon a mandatory microbiological test of the applied infusions detected a contamination with faecal germs (enterobacteria bacteria).

Both of the babies who died on Saturday were severely ill before they received the infusions. When the premature infant was born in the 24th week of pregnancy, the prognosis was very negative. The exact cause of death has not been determined yet but, no doubt, a contamination of infusions for babies and, in particular, for premature infants can be extremely dangerous.

How could contamination occur in an environment which traditionally stands for the highest standards in hygiene? Both the management of the hospital and hygiene experts are at a loss to understand this case. So is the state attorney who is in charge of investigations.

The infusions were prepared in the pharmacy department of the hospital, according to the therapeutic needs of the little patients. For this purpose a number of basic ingredients (like vitamins, electrolytes, carbohydrates, amino acids and others) are blended individually. In order to prevent germ formation the infusions are to be applied immediately.

Although a contamination of the delivered basic ingredients is not very likely, many hospitals have meanwhile intensified their microbiological tests or are using other suppliers until this source of contamination can be excluded. Considering the extremely high standards of the pharmacy industry, it seems to be more likely that the contamination happened in the pharmacy department of the hospital.

Looking at the workplace of the pharmacists it remains a mystery: a sterile surface of a sterile desk; all basic ingredients are sterile as well. The pharmacists have to wear sterile apparel, sterile masks and sterile gloves which cover their disinfected hands. Have some of these regulations been violated? The state attorney has to find out.

The death of three babies has drawn public attention to the sensitive subjects of hygiene and healthcare, ending in the question ‘how safe are our hospitals?’. Germany is confronted with alarming facts and figures: 600,000 patients are infected in hospitals, 40,000 die of a respective infection every year.

On the spot politicians demanded new regulations and laws; all political parties agree: something has to be done, initiatives have to be launched and the legislative body has to act immediately.  The political cacophony is a reaction to a well-known problem: MRSA. Multidrug-resistant germs have occupied European hospitals, though to a different degree. Scientists believe in a correlation between a frequent use of disinfectant agents in hospitals and MRSA; consequently, it is recommended to avoid such substances in private households.

But MRSA can also be found at public places like showers in sport facilities or washrooms. Therefore contract cleaners (and also their clients) should think twice about disinfectants and their risks: improper application can cause new resistant germs and turn a good intention into a bad result.

•See ECJ's special Hygiene for Health supplement with this issue.


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