3. Hygiene management

Throughout the world, increasing rates of infection make effective protection against the risks of infection indispensable for patients and employees. For this reason we have included hospital hygiene as a permanent part of our quality concept. The Group-wide hygiene management of RHÖN-KLINIKUM AG is a mix of centralised and decentralised organisation. Areas of focus of the central organisation are the recording and systematic, continuous monitoring of the sources of problems as well as comparing them with data within our hospitals and with national reference data (surveillance). RHÖN-KLINIKUM AG records data on infections or consumption of antibiotics systematically. Moreover, relevant quality indicators in the areas of sterilisation and preparation of instruments are gathered, while staffing of hygiene specialists at the facilities is centrally monitored.

During the past year, under the effective management of the hospital hygienists at RHÖN-KLINIKUM AG (Dr. Margret Seewald, Prof. Dr. Thomas Eikmann, Prof. Dr. Reinier Mutters) as well as the coordination by the Group divisions of Patient Safety, Quality Management and Hygiene, the human resources concept in the area of hospital hygiene for the Group’s hospitals was developed and adopted by the Medical Board. It has since been implemented at all sites. Furthermore, the relevant subject areas of hospital hygiene (surface disinfection, preparation of medical devices, screening, outbreak management and antibiotics stewardship) were discussed and agreed on. In respect of these subjects, a coordinated procedure at the facilities of RHÖN-KLINIKUM AG was developed in the first half of 2016 that was be adopted by the Medical Board in June.

The problem with resistance

Increasing antibiotics resistance of pathogens is one of the most urgent problems facing clinical facilities today. More and more bacteria are becoming insensitive to the effects of antibiotics. For persons with a weakened immune system, this is particularly a problem since their body’s own defences have no chance of fighting off the pathogens: if there is also resistance to antibiotics at the same time, that makes effective treatment all the more difficult. The most commonly known types of problematic pathogens in hospitals are MRSA and MRGN.

Staphylococcus aureus bacteria resistant to various antibiotics are referred to as MRSA: multi-resistant staphylococcus aureus bacteria. MRSA pathogens are often present in high concentrations in the nose, on the skin, in open wounds and sometimes also in bodily excretions of affected persons. Essentially, MRSA is transmitted to others through hand contact, but also sneezing and coughing. Usually, however, problems arise only when MRSA bacteria penetrate into the body through the surface of the skin.

Given this risk, RHÖN-KLINIKUM AG, before admitting a patient, carries out a 10-point screening procedure at each of its hospitals. We thus check whether any MRSA pathogens are present. If this is the case, certain measures such as disinfecting washings are initiated to remove these bacteria – but also to prevent the patients themselves from being infected post-operation. Moreover, patients in whom the presence of pathogens is detected at a later time are immediately isolated to prevent any possibility of other persons becoming infected.

What are referred to as multi-resistant gram-negative stab bacteria (MRGN) are even more robust than MRSA bacteria. These bacteria may even develop resistance to more than one antibiotic. High concentrations of MRGN bacteria may be present in the stool and urine, on the skin and mucous membrane or sometimes even in open wounds. MRGN pathogens are essentially transmitted to others through hand contact. That goes to show just how important regular and thorough hand disinfection is – for medical staff, patients and visitors.

With the expansion of organisation and employee qualification for the Antibiotic Stewardship programme, we are seeking to counteract the increasing development of resistance by hospital pathogens to hospital bacteria through optimised antibiotics therapy. In that way, we can not only improve the quality of patient treatment but can also achieve considerable cost savings. A study started in July 2015 is to conduct a scientific examination of the accuracy of risk-based screening for multiresistant pathogens within the facilities of RHÖN-KLINIKUM AG.

The findings will be used to develop a scientifically secure and standardised procedure for all hospital sites.