H Häfner

University Hospital RWTH Aachen , Aachen, North Rhine-Westphalia, Germany

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Publications (19)37.76 Total impact

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    ABSTRACT: The reduction of central venous line (CVL)-associated bloodstream infections (CLABSIs) is generally advocated. However, despite implementing infection prevention recommendations, CLABSI rates remain high at some institutions. Therefore, a chlorhexidine-containing dressing should be assessed for its potential for infection reduction, adverse events (AEs) and practicability. The number of CVLs, CVL days, CLABSIs and CLABSI rates with regard to the kind of dressing (standard vs. chlorhexidine-containing) were documented from November 2010 to may 2012 (1,298 patients with 12,220 CVL days) at two intensive care units (ICUs) and compared to historical controls. The practicability and safety of the chlorhexidine-containing dressing and reasons for not using this dressing were assessed. Forty CLABSIs occurred in 34 patients, resulting in a significantly lower overall CLABSI rate in patients with the chlorhexidine-containing dressing [1.51/1,000 CVL days; confidence interval (CI): 0.75-2.70] compared to patients with the standard dressing (5.87/1,000 CVL days; CI: 3.93-8.43; p < 0.0001). The CLABSI rate in historical controls receiving the standard dressing was 6.2/1,000 CVL days. The main reason for not using chlorhexidine-containing dressing was bleeding at the insertion site. AEs occurred in five patients and represented self-healing skin macerations (3 cases) and superficial skin necrosis (2 cases). In case of high CLABSI rates despite the implementation of standard recommendations, our findings suggest that a chlorhexidine-containing dressing safely decreases CLABSI rates.
    Infection 08/2013; · 2.44 Impact Factor
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    ABSTRACT: Here we investigated a cluster of eight newly Methicillin-resistant Staphylococcus aureus (MRSA)-colonized neonates at an ICU, and present data on molecular strain characterization as well as the source identification process in which we analyze the impact of MRSA-colonized HCWs. Molecular strain characterization revealed a unique pattern which was identified as spa-type t 127 - an extremely rare strain type in Germany. Environmental sampling and screening of parents of colonized neonates proved negative. However, staff screening identified one healthcare worker (HCW; 1/134) belonging to a group of recently employed Romanian HCWs who was colonized with the spa 127 strain. Subsequent screening also detected MRSA in 9/51 Romanian HCWs (18%) and 7/9 (14% of all) isolates showed the same molecular pattern as the index case (spa/PFGE type). All carriers were successfully decolonized, after which no new patient cases occurred. As a result, we have now implemented a universal screening programme of all new employees as part of our infection control management strategy. MRSA-colonized HCWs can act as a source for in hospital transmission. Since HCWs from high endemic countries are particular prone to being colonized, they may pose a risk to patients.
    International journal of hygiene and environmental health 07/2013; · 2.64 Impact Factor
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    Antimicrobial Resistance and Infection Control. 06/2013; 2(1).
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    ABSTRACT: PURPOSE: In a previous observational intervention study, we achieved a more than 100 % increase in overall hand hygiene (HH) compliance in the hemodialysis setting by increasing the number of hand rubs (HR) performed and concomitantly optimizing HH standard operating procedures (SOPs). SOPs were mainly aimed at reducing the number of avoidable opportunities due to a less than perfect workflow. However, the long-term sustainability of this successful intervention was not evaluated. The present study was carried out to evaluate the long-term effects of our previous successful intervention. METHODS: We conducted a follow-up observational study 1 year after the first intervention study in the same hemodialysis unit to assess the sustainability. No HH-related interventions were performed in the 1 year between studies. The main outcome was HH compliance, and the secondary outcome was opportunities per hemodialysis procedure. RESULTS: A total of 1,574 opportunities for HH and 871 hand rubs (HR) were observed during the follow-up observational study. Overall, compliance was 55 %, which was significantly than that at the end of the first study (62 %; p < 0.0001), but significantly higher than that at the start and mid-term phases of the first study (37 and 49 %, p < 0.0001). Both the decrease in HH opportunities and the increase in HR were sustained over the course of this observational study. The number of avoidable opportunities in the present study was similar to that at the end of the previous study. Thus, in 320 opportunities (20 %), gloves were worn instead of HR performed, representing 46 % of all missed HR. CONCLUSIONS: Despite a decrease in HH compliance compared to the last postintervention period, a multifaceted intervention focusing on standardization and workflow optimization resulted in a sustained improvement in HH. We therefore propose that standardization of the hemodialysis workflow aimed at improving HH is a promising avenue for improving the quality of patient care and outcome.
    Infection 02/2013; · 2.44 Impact Factor
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    ABSTRACT: Surgical site infections are mainly caused by bacteria from the patients' skin or gut flora representing endogenous infections. In orthopedic and trauma surgery the skin commensals dominate and as a consequence Gram-positive bacteria are the main pathogens, particularly S. aureus. Additionally and especially in the case of foreign body infections, less virulent pathogens, e.g. coagulase-negative staphylococci play an important role. Due to newer microbiological techniques in detecting pathogens the spectrum of causative organisms is steadily increasing. As known for other nosocomial infections the relevance of multidrug resistant bacteria in surgical site infections is growing and the key player is methicillin-resistant S. aureus (MRSA); however vancomycin-resistant enterococci (VRE), extended spectrum betalactamases and/or carbapenemases producing enterobacteria and recently even panresistant Acinetobacter baumannii isolates have to be considered.
    Der Orthopäde 01/2012; 41(1):6-10. · 0.51 Impact Factor
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    ABSTRACT: Viral gastroenteritis is common on pediatric wards, increasing the need for adherence with hand hygiene recommendations in order to prevent cross-transmission. Therefore, we investigated hand hygiene reflecting complete work-day activities on pediatric wards and focused on the influence of viral gastroenteritis. There are, so far, no studies representing complete working days on pediatric wards or addressing the influence of viral gastroenteritis. This was a prospective, observational study (144 h in each group) on hand hygiene behavior in the care for children with and without suspected or proven viral gastroenteritis. We documented 40 and 30 hand hygiene opportunities per patient-day for ward-associated healthcare workers for children with and without viral gastroenteritis, respectively (P = 0.316). Healthcare workers' compliance with hand hygiene recommendations was significantly higher in children with viral gastroenteritis compared to those without, i.e., 72 versus 67% (P = 0.033), especially among physicians, being 92 versus 50% (P = 0.032). Compliance tended to be higher after patient contact than before, especially in the children with gastroenteritis (78 vs. 62%; P = 0.083). We conclude that viral gastroenteritis seemed to increase the number of daily opportunities for hand hygiene and did significantly increase compliance. In particular, this effect was seen after patient contact. Further research might address the awareness of undiagnosed transmissible diseases in order to prevent cross-transmissions.
    Infection 06/2011; 39(4):359-62. · 2.44 Impact Factor
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    ABSTRACT: Hand hygiene is considered to be the single most effective measure to prevent healthcare-associated infection. Although there have been several reports on hand hygiene compliance, data on patients with multidrug-resistant (MDR) organisms in special isolation conditions are lacking. Therefore, we conducted a prospective observational study of indications for, and compliance with, hand hygiene in patients colonised or infected with meticillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing enterobacteria in surgical intensive and intermediate care units. Hand disinfectant used during care of patients with MRSA was measured. Observed daily hand hygiene indications were higher in MRSA isolation conditions than in ESBL isolation conditions. Observed compliance rates were 47% and 43% for the MRSA group and 54% and 51% for the ESBL group in the surgical intensive care unit and the intermediate care unit, respectively. Compliance rates before patient contact or aseptic tasks were significantly lower (17-47%) than after contact with patient, body fluid or patient's surroundings (31-78%). Glove usage instead of disinfection was employed in up to 100% before patient contact. However, compliance rates calculated from disinfectant usage were two-fold lower (intensive care: 24% vs 47%; intermediate care: 21% vs 43%). This study is the first to provide data on hand hygiene in patients with MDR bacteria and includes a comparison of observed and calculated compliance. Compliance is low in patients under special isolation conditions, even for the indications of greatest impact in preventing healthcare-associated infections. These data may help to focus measures to reduce transmission of MDR bacteria and improve patient safety.
    The Journal of hospital infection 10/2010; 76(4):320-3. · 3.01 Impact Factor
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    ABSTRACT: Data on time-dependency of external ventricular drainage (EVD)- and lumbar drainage (LD)-associated meningoventriculitis (MV) are scarce and discussions on the subject are controversial; no data exist for infection rates (IR) relative to drainage-days. For this reason, we conducted an observational study to determine time-dependent IRs and to perform a risk factor analysis. All patients (n = 210) requiring an EVD or LD during an 18-month period in 2007 and 2008 were enrolled and characterized. Data on type and duration of drainage, ICP measurement, number of drainage manipulations, hospital stay and time point of MV were analysed statistically. A total of 34 MV cases were reported with 17 for each kind of drainage accounting for an IR of 7.5 and 24.7 MV/1000 EVD- and LD-days, respectively. Of these, 28/34 MV (82%) occurred within the first 12 days, and IRs were highest between days 4 and 9. Longer drainage duration (>5 and >9 days, respectively) was correlated with a significant lower risk of MV (p = 0.03; p < 0.001). In this study, significant risk factors for MV were LD [vs. EVD, OR: 2.3 (1.1-4.7); p = 0.01], a previous MV [OR: 7.0 (2.1-23.3); p = 0.002], and neoplasm [OR: 11.6 (3.4-39); p = 0.001]. Simultaneous drainage, ICP and a previous drainage showed no influence on infection. To the best of our knowledge, this study is the first to provide data on time dependency of EVD- and LD-associated MV-IR based on drainage-days. However, because of the limited scale of our study, it would be desirable to confirm these results in a more powerful larger study. In conclusion, we recommend that future efforts should be made to better identify preventable risk factors as well as to define time periods of higher risk for the difficult-to-diagnose MV infection as a first step in profiling high risk patients.
    Infection 03/2010; 38(3):205-9. · 2.44 Impact Factor
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    ABSTRACT: Bloodstream infections (BSI) with gram-negative bacteria (GNB) are one of the most serious infections in the hospital setting, a situation compounded by the increasing antibiotic resistance of gram-negative bacteria causing BSI. The aim of the study was to assess the impact of antibiotic multiresistance of GNB in BSI on mortality rates and length of stay (LOS). The setting was the University Hospital Aachen, a 1,500-bed tertiary-care hospital with over 100 ICU beds providing maximal medical care in all disciplines. We performed a 5-year hospital-wide matched cohort study (January 1996 to February 2001) in which 71 cases and 99 controls were enrolled. Matching criteria were sex, age and GNB isolated in blood cultures. Multiresistance was defined as resistance against at least two different classes of antibiotics such as penicillins (+beta-lactamase-inhibitor), third-generation cephalosporins, fluoroquinolones or carbapenems. BSI were mainly nosocomially acquired, and cases of BSI with multiresistant bacteria were associated with a higher mortality (p=0.0418) and a prolonged LOS in the intensive care unit (ICU) (p=0.0049). Risk factors for BSI with multiresistant GNB were antibiotic treatment (p=0.0191) and mechanical ventilation (p=0.0283). Multiresistance of GNB causing BSI was associated with higher mortality rates and longer LOS in ICU. The initial antibiotic therapy was significantly more often inadequate and might have had an impact on overall mortality. Thus, an effective strategy to administer an appropriate initial empirical antibiotic therapy, especially in patients with risk factors, must be sought. Moreover, the overall usage of antimicrobials must be limited and infection control guidelines should be followed to reduce the emergence and transmission of multiresistant GNB.
    Infection 03/2008; 36(1):31-5. · 2.44 Impact Factor
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    ABSTRACT: Invasive fungal infections are associated with a high mortality and have been increasing in incidence over the last few decades. Candidemia and, less commonly, invasive pulmonary aspergillosis are the most relevant fungal infections in critical care medicine. Risk factors for systemic Candida infections are the use of broad-spectrum antibiotics, a prolonged stay in an intensive care unit and gastrointestinal injury or surgery. Invasive aspergillosis usually occurs in immunocompromised patients. The diagnosis of invasive fungal infections remains challenging. The therapeutic spectrum includes fluconazol, conventional and liposomal amphotericin B, and the recently introduced agents caspofungin and voriconazol. For rational and cost-effective use, the clinician requires precise knowledge of the indications and limitations of these agents. This review focuses on the diagnostic and therapeutic options in severe Candida infections and invasive aspergillosis.
    Der Anaesthesist 11/2005; 54(10):1047-64; quiz 1065-6. · 0.85 Impact Factor
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    ABSTRACT: Invasive Pilzinfektionen sind mit einer hohen Letalitt verbunden, und ihre Inzidenz steigt in den letzten Jahrzehnten an. Die Fungmie mit Candidaspezies und seltener die invasive pulmonale Aspergillose sind dabei die intensivmedizinisch bedeutsamsten Krankheitsbilder. Zu den Risikofaktoren fr systemische Candidainfektionen zhlen z.B. Breitspektrumantibiotika, eine lange intensivmedizinische Behandlung und eine Verletzung/Operation im Bereich des Gastrointestinaltraktes. Immunsupprimierte Patienten sind typischen Risikopatienten fr eine invasive Aspergillusinfektion. Whrend die Diagnostik von invasiven Pilzinfektionen den Arzt weiterhin vor erhebliche Schwierigkeiten stellt, konnten in den letzten Jahren die Therapieoptionen verbessert werden. Neben Fluconazol, konventionellem und liposomalem AmphotericinB stehen neue Prparate wie Caspofungin und Voriconazol zur Verfgung. Um Antimykotika rational und kosteneffektiv einzusetzen, bentigt der Arzt Kenntnisse ber ihre Indikationen und Grenzen. In diesem Beitrag sollen die Diagnostik und die aktuellen Therapieoptionen von intensivmedizinisch relevanten Aspergillus- und Candidainfektionen dargestellt werden.Invasive fungal infections are associated with a high mortality and have been increasing in incidence over the last few decades. Candidemia and, less commonly, invasive pulmonary aspergillosis are the most relevant fungal infections in critical care medicine. Risk factors for systemic Candida infections are the use of broad-spectrum antibiotics, a prolonged stay in an intensive care unit and gastrointestinal injury or surgery. Invasive aspergillosis usually occurs in immunocompromised patients. The diagnosis of invasive fungal infections remains challenging. The therapeutic spectrum includes fluconazol, conventional and liposomal amphotericin B, and the recently introduced agents caspofungin and voriconazol. For rational and cost-effective use, the clinician requires precise knowledge of the indications and limitations of these agents. This review focuses on the diagnostic and therapeutic options in severe Candida infections and invasive aspergillosis.
    Der Anaesthesist 09/2005; 54(10):1047-1066. · 0.85 Impact Factor
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    ABSTRACT: We assessed data on the epidemiology of nosocomial infections (NIs) in a 14-bed neurosurgical intensive care unit (NSICU) and used surveillance data for the promotion of quality improvement activities. Prospective periodic surveillance was performed over five 3-month periods between July 1998 and October 2002 on all patients admitted with a length of stay > 24 hours. 763 patients with a total of 4,512 patient days and a mean length of stay of 5.9 days were enrolled within the 15-month study period. A total of 93 NIs were identified in 82 patients. Urinary tract infections (24.7%), pneumonia (23.6%), and bloodstream infections (17.2%) were the most frequent NIs recorded. Device-associated incidence rates were 6.0 (3.8-9.0, CI(95%)) for urinary tract infection, 4.4 (2.4-7.4, CI(95%)) for bloodstream infection, and 10.3 (6.3-15.9, CI(95%)) for pneumonia per 1,000 days at risk. For improvement of infection control-related processes, evidence-based infection control guidelines were established and an NSICU nurse was designated to be responsible for infection control issues on the ward. In addition, several infection control problems arose during the observation periods and were rapidly responded to by introducing specific intervention strategies. Periodic surveillance is a valuable tool for assessing the epidemiology of NIs in the NSICU setting as well as for promoting the initiation of quality improvement activities.
    Infection 07/2005; 33(3):115-21. · 2.44 Impact Factor
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    ABSTRACT: The serum bactericidal test measures the highest level of an antibiotic-containing serum dilution at which 99.9% of bacteria are killed. In this study the serum bactericidal activity of piperacillin/tazobactam was determined for bacteria often involved in severe infections. In earlier studies titres >/=1:8 in the serum bactericidal tests correlated well with clinical success in the treatment of endocarditis and osteomyelitis as well as bacterial eradication. Blood samples of 6 healthy volunteers were taken before and 1 and 4 h after piperacillin/tazobactam (4.5 g) administration. Serum concentrations and serum bactericidal activity were determined for 10 strains each of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, both piperacillin-resistant and piperacillin-susceptible according to NCCLS guidelines. 100% of S. aureus and piperacillin-susceptible E. coli, 90% of piperacillin-resistant E. coli and 80% of P. aeruginosa were killed 1 h after drug administration. 4 h after drug administration serum bactericidal activity decreased to 60% for S. aureus, 90% for piperacillin-susceptible E. coli, 80% for piperacillin-resistant E. coli and 30% for P. aeruginosa. Excellent serum bactericidal activity of piperacillin/tazobactam was recorded 1 h after drug administration for S. aureus, E. coli and P. aeruginosa. After 4 h limited killing rates for P. aeruginosa could be detected, which supports the idea of a combination therapy.
    Chemotherapy 04/2004; 50(1):27-30. · 2.07 Impact Factor
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    ABSTRACT: We prospectively studied the difference in detection rates of multi-resistant Gram-positive and multi-resistant Gram-negative bacteria in the inanimate environment of patients harbouring these organisms. Up to 20 different locations around 190 patients were surveyed. Fifty-four patients were infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) and 136 with multi-resistant Gram-negative bacteria. The environmental detection rate for MRSA or VRE was 24.7% (174/705 samples) compared with 4.9% (89/1827 samples) for multi-resistant Gram-negative bacteria (P<0.001). Gram-positive bacteria were isolated more frequently than Gram-negatives from the hands of patients (P<0.001) and hospital personnel (P=0.1145). Environmental contamination did not differ between the intensive care units (ICUs) and the general wards (GWs), which is noteworthy because our ICUs are routinely disinfected twice a day, whereas GWs are cleaned just once a day with detergent. Current guidelines for the prevention of spread of multi-resistant bacteria in the hospital setting do not distinguish between Gram-positive and Gram-negative isolates. Our results suggest that the inanimate environment serves as a secondary source for MRSA and VRE, but less so for Gram-negative bacteria. Thus, strict contact isolation in a single room with complete barrier precautions is recommended for MRSA or VRE; however, for multi-resistant Gram-negative bacteria, contact isolation with barrier precautions for close contact but without a single room seems sufficient. This benefits not only the patients, but also the hospital by removing some of the strain placed on already over-stretched resources.
    Journal of Hospital Infection 03/2004; 56(3):191-7. · 2.86 Impact Factor
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    ABSTRACT: In addition to MIC and MBC tests in this study the serum bactericidal activity of 3.1 microg/ml of moxifloxacin or 5.2 microg/ml of levofloxacin was determined against ten susceptible strains of S. aureus, S. epidermidis, E. coli and K. pneumoniae. Moxifloxacin achieved markedly better activity against S. aureus and S. epidermidis as compared to levofloxacin. Activity of moxifloxacin against E. coli and K. pneumoniae was excellent but not superior to levofloxacin. In conclusion both fluorquinolones are highly effective against E. coli and K. pneumoniae, moxifloxacin being superior with respect to gram-positives like S. aureus and S. epidermidis.
    Chemotherapy 06/2003; 49(1-2):33-5. · 2.07 Impact Factor
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    Journal of Antimicrobial Chemotherapy 02/2001; 47(1):118-20. · 5.34 Impact Factor
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    ABSTRACT: A routine infectious disease service was established in January 1998 in order to optimize the antibiotic usage and prescription pattern of a neurologic intensive care unit (NICU). Treatment guidelines for the most prevalent infections were implemented and individual antibiotic regimes were discussed at the bedside with infectious disease experts. This interdisciplinary cooperation reduced the total number of antibiotics prescribed by 38.1%, from 7,789 in 1997 to 4,822 in 1998, without compromising patient outcomes (mortality rate: 22/313 patients in 1997 vs. 32/328 patients in 1998). Total patient days (2,254 days vs. 2,296 days) and average length of stay in the NICU (7.2 days vs. 7.0 days) were comparable. Antimicrobial expenditure decreased by 44.8% (71,680 Euros in 1997 vs 39,567 Euros in 1998). Taking into account the costs for the infectious disease service (approximately 8,000 Euros in 1998), a total saving of 24,113 Euros was made. The dramatic reduction in antibiotic usage (mainly of carbapenems) resulted in a statistically significant decreased isolation of Stenotrophomonas maltophilia (p<0.05), Enterobacter cloacae (p<0.05), multiresistant Pseudomonas aeruginosa (p<0.05) and Candida spp. (p<0.05), without any change in the infection control guidelines. These data show that an infectious disease service can optimize and reduce antibiotic usage. This results in a decrease in the occurence of multiresistant gram-negative pathogens and Candida spp. in intensive care units and, at the same time, saves costs.
    Infection 01/2000; 28(6):384-7. · 2.44 Impact Factor
  • International Journal Of Medical Microbiology. 299:74-74.
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    ABSTRACT: Die Erreger postoperativer Wundinfektionen sind vornehmlich endogenen Ursprungs, d. h. es handelt sich um Bakterien der physiologischen Patientenflora. In den Bereichen Orthopädie/Unfallchirurgie kommt der physiologischen Hautflora die wichtigste Rolle zu. Als Konsequenz dominieren grampositive Bakterien; der häufigste Infektionserreger ist S. aureus. Bei fremdkörperassoziierten Infektionen spielen auch niedrigpathogene Erreger wie koagulasenegative Staphylokokken eine wichtige Rolle. Bedingt durch neuere Nachweismethoden in der Mikrobiologie erweitert sich das Spektrum der Infektionserreger stetig. Wie auch bei anderen nosokomialen Infektionen nimmt der Stellenwert multiresistenter Erreger auch für die postoperative Wundinfektion zu. Dabei sind neben Methicillin-resistenten S.-aureus-Stämmen auch Vancomycin-resistente Enterokokken, Extended-spectrum-beta-Laktamase-/Carbapenemase bildende Enterobakterien und panresistente Acinetobacter-baumannii-Isolate von Relevanz.
    Der Orthopäde 41(1). · 0.51 Impact Factor

Publication Stats

171 Citations
37.76 Total Impact Points

Institutions

  • 2001–2013
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 2005–2012
    • RWTH Aachen University
      • Central Unit of Hospital Hygiene and Infectious Diseases
      Aachen, North Rhine-Westphalia, Germany