U Heudorf

Gesundheitsamt Frankfurt, Frankfurt, Hesse, Germany

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Publications (137)154.51 Total impact

  • U Heudorf
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    ABSTRACT: Infection prevention is one of the main tasks of the public health services. The "Protection against infection act" places all medical institutions and facilities for children (kindergartens and schools) under the obligation to assume responsibility and to cooperate. Duties of the institutions are described, and public health services are obliged to perform hygiene control visits.Regarding medical institutions, the guidelines of the German Commission on Hospital Hygiene and Infection Control have to be observed, and the counties were obliged to publish hygiene enactments. Subsequently, good improvements in hygiene management in medical institutions were achieved. In schools, however, severe hygienic problems (i.e. sanitary hygiene, indoor air hygiene) are detected, without any improvement - obviously due to a missing sense of responsibility in the school community.Causes for poor behaviour prevention (hand hygiene, ventilation) and missing situational prevention (i.e. cleaning) are discussed. Without reversion to the obviously needed but nearly forgotten subject school hygiene, obligatory guidelines and the assuming of responsibility, permanent improvements cannot be achieved. © Georg Thieme Verlag KG Stuttgart · New York.
    Das Gesundheitswesen 07/2015; DOI:10.1055/s-0035-1550021 · 0.62 Impact Factor
  • T Westphal, K Voigt, U Heudorf
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    ABSTRACT: Background: The first and second amendment to the Drinking Water Ordinance came in to force in the years 2011 and 2012 causing additional tasks and responsibilities for operators of commercial large-scale systems, usually hot water systems in large residential buildings, and for the local health authorities. This article describes the experiences of the health authority in Frankfurt/Main with these new regulations. Some of the revisions in the first amendment of the ordinance (TrinkwV 2001 (2011)) were omitted in the second revision (TrinkwV 2001 (2012)) such as the obligation to notify for large-scale systems. Furthermore, the intervals between the obligatory inspections were extended from 1 to 3 years and merely exceedances of the legal limits were to be notified in contrast to the previous obligation to notify all values. Results: On the basis of the TrinkwV 2001 (2011) a large additional staff requirement had been estimated (13/21 positions). After the TrinkwV 2001 (2012) the tasks can be accomplished by less than 2 employees. While the notification obligation was still in force, the health authority received 4 461 notifications of large-scale systems, since then a further 477 have been notified. Of a total of 1 335 initial analyses, 794 (60%) exceeded the technical action value and in 113 properties with values exceeding 10 000/100 ml a usage restriction was necessary. Conclusions: Due to the suspension of the notification obligation to report any result of the analyses performed the assessment of the reports on large-scale systems has become difficult. An appropriate assessment of the implementation of the regulation is not possible, since the total number of large-scale systems is not known and a failure to report may result from a measured value below the technical action value as well as from a not inspected system. The large number of usage restrictions is an indication for the necessity to inspect and if required to treat and restore the system. © Georg Thieme Verlag KG Stuttgart · New York.
    Das Gesundheitswesen 07/2015; DOI:10.1055/s-0035-1550027 · 0.62 Impact Factor
  • A Hausemann, H Hofmann, U Otto, Ursel Heudorf
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    ABSTRACT: In addition to hand hygiene and reprocessing of medical products, cleaning and disinfection of surfaces is also an important issue in the prevention of germ transmission and by implication infections. Therefore, in 2014, the quality of the structure, process and result of surface preparation of all hospitals in Frankfurt am Main, Germany, was monitored. All 17 hospitals transferred information on the quality of structure. Process quality was obtained through direct observation during cleaning and disinfection of rooms and their plumbing units. Result quality was gained using the fluorescent method, i.e. marking surfaces with a fluorescent liquid and testing if this mark has been sufficiently removed by cleaning. Structure quality: in all hospitals the employees were trained regularly. In 12 of them, the foremen had the required qualifications, in 6 hospitals unclarity as to the intersection of the cleaning and care services remained. In 14 hospitals only visible contamination was cleaned on the weekends, whereas complete cleaning was reported to take place in 12 hospitals on Saturdays and in 2 hospitals on Sundays. The contractually stipulated cleaning (observations specified in brackets) averaged 178 m(2)/h (148 m(2)/h) per patient room and 69 m(2)/h (33 m(2)/h) for bathrooms. Process quality: during process monitoring, various hand contact surfaces were prepared insufficiently. Result quality: 63 % of fluorescent markings were appropriately removed. The need for improvement is given especially in the area of the qualification of the foremen and a in a clear definition of the intersection between cleaning and care services, as well as in the regulations for weekends and public holidays.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 04/2015; DOI:10.1007/s00103-015-2150-5 · 1.01 Impact Factor
  • U Heudorf, A Hausemann
    Das Gesundheitswesen 04/2015; 77(04). DOI:10.1055/s-0035-1546879 · 0.62 Impact Factor
  • Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin 01/2015; 20(26). · 4.66 Impact Factor
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    ABSTRACT: Endoscopy is an important part of modern medical diagnostics and therapy. The invasive procedures are however associated with a risk to transmit infections. Against this background the KRINKO has published the "Hygienic requirements for the reprocessing of flexible endoscopes and endoscopic accessories" in 2002 and has updated these recommendations in 2012. In 2003 and 2013 all gastroenterological facilities in Frankfurt am Main using flexible endoscopes were monitored for compliance with the recommendations. The inspections were performed after prior notice by a staff member of the health authority using a checklist which had been developed on the basis of the current KRINKO recommendations. In both years all institutions performing endoscopic procedures were visited: 2003 15 hospitals and 23 practices; 2013 14 clinics and 10 practices. In 2013 (data for 2003 in brackets) 100 % (93 %) of the hospitals and 60 % (22 %) of practices reprocessed their endoscopes by automated methods. The appropriate reprocessing and filling of water bottles for rinsing the scope channels with sterile water and the sterilisation of accessories were satisfactorily performed in 2003 and 2013 by all hospitals. However in 2013 only 90 % (2003: 74 %) of the practices correctly reprocessed water bottles and 80 % (52 %) used sterile water for filling the bottle. In 2013 100 % (2003: 57 %) of the practices correctly sterilised accessory instruments, while 2 practices used disposable, i. e., single-use materials. In 2013 all institutions performed microbiological tests according to KRINKO recommendations, while in 2003 all hospitals but only 43 % of the practices could present such tests. While the gastroenterological departments of Frankfurt hospitals already complied with the KRINKO recommendations in 2003, the inspection of several practices in 2003 had revealed considerable shortcomings in the implementation of these recommendations. Subsequently the practices have improved their hygiene management. © Georg Thieme Verlag KG Stuttgart · New York.
  • Ursel Heudorf, R Gottschalk, M Exner
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    ABSTRACT: Antimicrobial-resistant organisms are regarded as a particular threat to the public health of the European population. In Germany the requirement for a national rollout reporting of positive laboratory test results for methicillin-resistant Staphylococcus aureus (MRSA) in blood cultures was implemented in 2009. This was followed in 2011 by the introduction of a laboratory-based, rollout reporting system for the detection of gram-negative bacteria with acquired carbapenem-resistance (carbapenem-resistant organisms, CRO) in the federal state of Hessen. This article will present the experience gained in Frankfurt am Main with the existing reporting system. Blood or cerebrospinal fluid cultures positive for MRSA were reported from all Frankfurt clinics between 2010 and 2013. The objective of preventing nosocomial infections by introducing a mandatory reporting for MRSA in blood cultures was only partially achieved by the reporting procedure on a population scale. Instead, reporting on a clinic-based scale, i.e., incidence per 1,000 patient days should be used. Moreover, mandatory reporting of clusters of nosocomial colonizations with MRSA could be an appropriate measure for the timely prevention of nosocomial infections with these organisms. CROs were reported from nearly all clinics as well as the ambulatory setting. Different reporting criteria have resulted not only in a greatly varying workload for the institutions and the health authorities but also in vastly different numbers of reported events. Regarding the importance of CRO, mandatory reporting seems reasonable. Criteria of reporting should be simple and easily comprehensible, i.e., all 4MRGN (gram-negative bacteria with resistance against four antibiotic groups such as acylureidopenicillins, third- and fourth-generation cephalosporins, fluorchinolones, and carbapenems) according to the German Commission on Hospital Hygiene and Infection Prevention (KRINKO) should be considered. Reporting and evaluation of multidrug-resistant organisms (MDRO) in a population-based system does not seem to be sufficient regarding these organisms with high importance for hospital hygiene; mandatory reporting on an anonymous clinic-based scale should be used.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 10/2014; 57(11). DOI:10.1007/s00103-014-2046-9 · 1.01 Impact Factor
  • M Schade, U Heudorf, C Hornberg
    Das Gesundheitswesen 09/2014; 76(08/09). DOI:10.1055/s-0034-1387005 · 0.62 Impact Factor
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    ABSTRACT: Background The federal state of Hesse, Germany, introduced a laboratory-based reporting scheme for carbapenem-resistant organisms (CROs). Method The results of the first year of mandated reporting of CROs from April 2012 through March 2013 to the Public Health Authority of Frankfurt/Main, responsible for a population of 700,000 inhabitants, are described. Results Within a period of 12 months 243 CROs were notified to the health authority. Of these 213 isolates had been reported from 16 of the 17 hospitals in Frankfurt/Main, 6 from ambulatory settings and 24 from clinics outside of Frankfurt/Main. Mean incidence rate per 1,000 patient days in hospitals was 0.138 (range 0.02-0.28). Conclusion In Frankfurt/Main almost all hospitals have reported CROs in the study period though the frequency of isolation varies strongly and many facilities only report CROs sporadically. Molecular data indicate a high diversity of different carbapenemases. Autochthonous transmission must be assumed despite the absence of major outbreaks. Rapid and coordinated efforts by clinicians and health departments are crucial to control the spread of CRO infections. The mandatory reporting scheme provides important data to guide the implementation of preventive measures.
    BMC Infectious Diseases 08/2014; 14(1):446. DOI:10.1186/1471-2334-14-446 · 2.61 Impact Factor
  • U Heudorf, M Schade
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    ABSTRACT: Following the heat wave of August 2003 that caused over 70,000 fatalities in Western Europe, heat-health action plans (HHAP) and heat warning systems were implemented in many European countries, including Germany. The effect of these preventive measures (informing the population as well as nursing and medical personnel) on excess mortality during heat waves in Frankfurt am Main, Germany, is studied, taking into account newly published data on a modifying effect of air pollution on heat mortality. Mortality data comprising all deaths registered in the city of Frankfurt was obtained from the statistical state office; air temperature and air pollution data in Frankfurt Ost were obtained from the Hessian state office for environment and geology. SPSS Version 15 was used for statistical analysis (bivariate and partial correlations, nonparametric tests/Kruskal-Wallis, and Mann-Whitney test).
    Zeitschrift für Gerontologie + Geriatrie 07/2014; 47(6). DOI:10.1007/s00391-014-0673-2 · 1.02 Impact Factor
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    ABSTRACT: Residents of long-term care facilities (LTCF) are at risk of healthcare associated infections (HAI) and are often treated with antibiotics. In Germany a current HAI prevalence of 1.6 % and antibiotic use in 1.15 % have been reported. However, data published on the current prevalence of multidrug-resistant organisms (MRDO) in LTCFs in Germany are scarce. Therefore, the prevalence of HAI, antibiotic use and presence of MDROs were investigated in LTCF residents in Frankfurt am Main, Germany. A point prevalence study of HAI and antibiotic use according to the European HALT protocol (health care associated infections in long-term care facilities) was carried out; swabs from the nose, throat and perineum were analyzed for methicillin-resistant Staphylococcus aureus (MRSA), extended spectrum beta-lactamase producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE). A total of 880 residents in 8 LTCFs were enrolled in the study in 2012. The study participants were 30 % male, 46.7 % were more than 85 years old, 70 % exhibitied urinary or fecal incontinence, 11.4 % had an indwelling urinary catheter and 0.1 % a vascular catheter. Prevalence rates of HAI and of antibiotic use were 2.5 % and 1.5 %, respectively. The prevalence of MDROs in 184 residents who agreed to being tested for MDROs was 9.2 % MRSA, 26.7 % ESBL and 2.7 % VRE. The HAIs and antibiotic use were comparable to the German HALT data from 2010. Compared to other German studies there is a steadily increasing MRSA problem in German LTCFs. High and increasing ESBL rates have been detected in German LTCFs. Further studies are needed to confirm this trend, preferably encompassing molecular methods to study epidemiology.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 04/2014; 57(4):414-22. DOI:10.1007/s00103-013-1927-7 · 1.01 Impact Factor
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    ABSTRACT: Multidrug-resistant organisms (MDROs) are not only a problem in the hospital but also in the community setting. The MRE-Net Rhine-Main was founded in order to decrease the rate of development and spread of MDROs in the region and to counter the stigmatisation of people with MDROs. The network attempts to achieve these goals by offering telephone support, information flyers, internet services, information events and training for health-care practitioners from hospitals (HOSP), residential and nursing homes (RNH), outpatient care services (OCS), emergency services (ES), medical practices (MP) and rehabilitation centers (RC). A first interim evaluation examined the expectations each institution had associated with its participation and how well these objectives were fulfilled. Furthermore the utilisation and acceptance of the services offered by the network were investigated.The participating institutions (n=143) received a standardised questionnaire adapted to the type of institution by mail including questions focusing on the above-mentioned issues.96 questionnaires could be evaluated (response 67.1%). More than 90% of the participants expected to participate in trainings, receive improved information, to gain more confidence in handling patients and to improve hygiene measures - with great differences between HOSP, RNH and OCS. These expectations were largely satisfied. 65.5% of the institutions participated at least once in a training, particularly RNH, OCS, whereby the usefulness of the trainings was rated high by these institutions. 14.4% of the institutions had made use of the telephone service, the gain of information was rated as high by HOSP, RNH and OCS. 81% knew of and used the flyers, but almost half of the institutions did not know the homepage of the network.Overall the expectations of the network participants were met well to very well and the benefit derived from the trainings and the print and online media was rated as high. Therefore the network will continue and further intensify its work.
    Das Gesundheitswesen 03/2014; DOI:10.1055/s-0034-1367008 · 0.62 Impact Factor
  • U Heudorf
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    ABSTRACT: According to the "Protection against Infection Act", public health services are obliged to supervise and consult the hygienic conditions not only in hospitals but also in ambulatory medical practices in Germany. Firstly, in this paper basic principles on transmission routes of pathogenic germs and general remarks on the infection control visits as well as on the special regulations (i. e., German commission on hospital hygiene and infection prevention) are described. Secondly, crucial points to be considered in all medical practices are mentioned. Finally, special issues in different practices are reported, such as dermatology, gastroenterology, gynaecology, paediatrics etc. This article aims to support the public health departments in their task to prevent infections in patients and personnel in medical practices.·
    Das Gesundheitswesen 11/2013; 75(11):697-704. DOI:10.1055/s-0033-1357165 · 0.62 Impact Factor
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    ABSTRACT: Nicht nur angesichts der sehr häufigen Infektionen bei Kindern, sondern auch wegen des entwicklungsgemäßen kindlichen Verhaltens (Krabbeln auf dem Boden, ,,mouthing“) besteht in der kinder- und jugendärztlichen Praxis ein besonderes Risiko der Erregerübertragung, obwohl dort im Vergleich mit anderen Praxen vergleichsweise wenige invasive Maßnahmen (Blutentnahmen, Infusionen, Katheter usw.) vorgenommen werden. Eine Aufbereitung kritischer Medizinprodukte findet in Kinder- und Jugendarztpraxen praktisch überhaupt nicht statt.Sachgerechte Hygiene in kinder- und jugendärztlichen Praxen (ohne Medizinprodukteaufbereitung) setzt Folgendes voraus: ein Personal, das die Infektionsrisiken und v. a. die Übertragungswege kennt und sich entsprechend verhält, insbesondere eine gute Händehygiene und Flächendesinfektion vornimmt. Diese Maßnahmen sind nicht teuer, aber wirkungsvoll, auch bei der zunehmenden Problematik der multiresistenten Erreger. Eine gute Hygiene sicherzustellen, liegt in der Verantwortung der Praxisinhaber und Mitarbeiter selbst, zum Schutz von Patienten und Personal vor Infektionen – und nicht zuletzt auch zum Schutz vor Beschwerden oder Prozessen.
    Monatsschrift Kinderheilkunde 10/2013; 161(10). DOI:10.1007/s00112-013-3005-5 · 0.28 Impact Factor
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    ABSTRACT: Since July 1st, 2009 in accord with the statuary order based on the German law for infectious diseases (Infektionsschutzgesetz), MRSA in blood and liquor have to be notified to the public health authorities. The aim of this extension of the notification to report is to improve the surveillance of nosocomial infections and the prevention of nosocomial MRSA infections. In this paper data of the notifications in the year 2011 within the MDRO-Net Rhine-Main, an association of 7 public health authorities in the region, are reported in order to investigate whether the aims of the obligation for notification could be achieved.In 2011, 138 MRSA bloodstream infections, including 1 MRSA in liquor culture, were notified to the 7 health protection authorities, resulting in an incidence rate of 5.6/100 000 inhabitants. In urban regions with more hospitals available, the incidence rate was higher than in rural districts with less medical facilities (6.9 vs. 4.4/100 000 inhabitants). Only 46 (35%) of the patients with MRSA cultured in their blood had been detected via anamnesis as patients on risk for MRSA, and 59 (45%) had been screened for MRSA on admission. The incidence rate in the different hospitals was 0.041±0.031/1 000 patient days (range 0-0.145/1 000 patient days).For the first time, data on notification of MRSA cultures in blood specimen are published from a whole MRE Network in Germany encompassing >2.1 million inhabitants. Incidence rates per 100 000 inhabitants alone do not seem adequate to cope with the aims of the obligation for notification. Instead, reference to patient days in the respective clinic enables an external comparison to other medical institutions in the region and is a better base for discussion with these institutions on improvements of surveillance, screening and hygiene.
    Das Gesundheitswesen 08/2013; 76(6). DOI:10.1055/s-0033-1349871 · 0.62 Impact Factor
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    ABSTRACT: Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n=46), 8 nursing homes (n=178), and 2 ambulant care facilities (n=64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5-4.9; p=0.002), urinary catheter (OR: 3.1, 95% CI: 1.7-5.9; p<0.001), former hospitalization (OR: 2.1, 95% CI: 1.1-4.0; p=0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5-4.9; p=0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.
    International journal of medical microbiology: IJMM 05/2013; 303(8). DOI:10.1016/j.ijmm.2013.05.002 · 3.42 Impact Factor
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    ABSTRACT: Background: The Rudolf Schuelke Foundation addresses topics related to hygiene, infection prevention and public health. In this context a
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    ABSTRACT: Background: The Rudolf Schuelke Foundation addresses topics related to hygiene, infection prevention and public health. In this context a panel of scientists from various European countries discussed “The Role of Surface Disinfection in Infection Prevention”. The most important findings and conclusions of this meeting are summarised in the present consensus paper. Aim: Although the relevance of surface disinfection is increasingly being accepted, there are still a number of issues which remain controversial. In particular, the following topics were addressed: Transferral of microbes from surface to patients as a cause of infection, requirements for surface disinfectants, biocidal resistance and toxicity, future challenges. Methods and findings: After discussion and review of current scientific literature the authors agreed that contaminated surfaces contribute to the transmission of pathogens and may thus pose an infection hazard. Targeted surface disinfection based on a risk profile is seen as an indispensable constituent in a multibarrier approach of universal infection control precautions. Resistance and cross-resistance depend on the disinfectant agent as well as on the microbial species. Prudent implementation of surface disinfection regimens tested to be effective can prevent or minimize adverse effects. Conclusions: Disinfection must be viewed as a holistic process. There is a need for defining standard principles for cleaning and disinfection, for ensuring compliance with these principles by measures such as written standard operating procedures, adequate training and suitable audit systems. Also, test procedures must be set up in order to demonstrate the efficacy of disinfectants including new application methods such as pre-soaked wipes for surface disinfection.
    04/2013; 8(1):Doc10. DOI:10.3205/dgkh000210
  • Das Gesundheitswesen 04/2013; 75(04). DOI:10.1055/s-0033-1337558 · 0.62 Impact Factor
  • M Schade, U Heudorf, C Hornberg
    Das Gesundheitswesen 04/2013; 75(04). DOI:10.1055/s-0033-1337526 · 0.62 Impact Factor

Publication Stats

1k Citations
154.51 Total Impact Points

Institutions

  • 1995–2015
    • Gesundheitsamt Frankfurt
      Frankfurt, Hesse, Germany
  • 2001–2013
    • Frankfurt City Public Health Office
      Frankfurt, Hesse, Germany
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Occupational Social and Environmental Medicine and Policlinic
      Erlangen, Bavaria, Germany
  • 2004–2009
    • University of Bonn
      • Institute for Hygiene and Public Health
      Bonn, North Rhine-Westphalia, Germany