U Heudorf

Gesundheitsamt Frankfurt, Frankfurt, Hesse, Germany

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Publications (180)194.08 Total impact


  • No preview · Article · Jan 2016 · European communicable disease bulletin
  • U Heudorf · D Färber · D Mischler · M Schade · C Zinn · D Nillius · M Herrmann
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    ABSTRACT: Background: Many regional German MDRO-networks aim to improve the medical rehabilitation of patients with methicillin-resistant Staphylococcus aureus (MRSA) and other multidrug-resistant pathogens. In 2014, the German Commission for Hospital Hygiene and Infection Control (KRINKO) released revised recommendations for the care of patients with MRSA. In particular, for rehabilitation facilities, these recommendations stipulated a medical risk analysis to establish necessary hygiene measures, and provide specific recommendations. Material and Methods: Based on a large investigation carried out in 21 rehabilitation facilities covering different medical specialties, medical risk analyses according to KRINKO were performed, and the findings evaluated separately for orthopedic, cardiologic, oncologic, neurologic, or geriatric facilities, as well as for all institutions taken together. Results: The overall colonization pressure, i. e. the point prevalence of MRSA and extended spectrum beta-lactamase-producing gram-negative pathogens (ESBL) among hospitalized rehabilitation patients was found to be 0.7% and 7.7%, respectively. Impairment of the intact skin (an established risk factor for persisting MRSA colonization and MRSA infection) was found in 7% of the patients, impaired mobility requiring enhanced level of care in 4.1%, and mental confusion and/or incontinence (potentially impairing the application of hygiene measures) in 11% of patients. Compared to the total study population, there was an increase in all risk factors in geriatric and neurologic rehabilitation patients: skin barrier breaches (in neurologic and in geriatric patients: 18.3 and 19.2%, respectively), impaired mobility (32.7 and 37.0%, respectively), and mental confusion/incontinence (24.5 and 28.0%, respectively). In addition, geriatric patients demonstrated an increased overall prevalence of multidrug-resistant organisms (MRSA: 9.4%; ESBL: 22.7%). Discussion: Risk analysis according to KRINKO showed that in rehabilitation facilities with internal medicine or orthopedics specialties, there was a comparably lower risk for transmission, colonization, and/or infection with multidrug-resistant pathogens, as against institutions with neurologic or geriatric specialty. It appears that in the first type of rehabilitation facilities, consistently carried out basic hygiene measures are sufficient while in neurologic or geriatric rehabilitation hospitals, these measures should be supplemented with additional hygiene measures based on medical risk analysis. Furthermore, for infection control purposes in rehabilitation facilities, patient isolation will be rarely necessary or appropriate. These analyses suggest that in the future, rehabilitation programs for MRSA/ESBL-colonized patients will be more successful.
    No preview · Article · Dec 2015 · Die Rehabilitation
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    ABSTRACT: Background: Data on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in outpatient care are scarce and those on the prevalence of multidrug-resistant Gram-negative bacteria (MRGN) are lacking completely. Therefore, the network on multidrug-resistant organisms (MDRO) in the Rhine-Main region (MRE-Netz Rhein-Main) performed a multicenter study on current prevalence data and risk factors for MDRO. Materials and methods: Characteristics of all patients were obtained according to a modified healthcare-associated infections in long-term care facilities (HALT) questionnaire and swabs from the nares/throat and anus were tested for MRSA and extended-spectrum beta-lactamase (ESBL)/MRGN. Risk factors were calculated via odds ratios. Results: Ten nursing services with 486 patients participated in this study, 269 patients agreed to having swabs of the nares/throat taken, and 132 patients had anal swabs. MRSA was detected in 3.7 %, and ESBL/MRGN in 14.4 % of the patients (6.8 % ESBL, 7.6 % MRGN, 0 % MRGN). Risk factors for MRSA were high dependency on care (stage 3 or above; OR 5.1), antibiotic use during the preceding 3 months (O R 3.7), hospital stay during the last 6 months (OR 4.3), and a positive history for MRSA (OR 18.1). Incontinence and preceding hospital stays proved to be risk factors for ESBL colonization (OR 9.5 or 6.5), whereas risk factors for MRGN colonization were a high level of care dependency (OR 7.5), urinary catheter (OR 8.3), percutaneous endoscopic gastrostomy tube and other stomata (OR 6.2), and artificial respiration (OR 5), in addition to a positive history for MRSA (OR 20) and ESBL (OR 6.7). Conclusion: Considering the high prevalence of colonization with MDRO in outpatient care, nursing services must be competent in caring for such patients: good hygiene procedures, including hand hygiene and appropriate handling in wound management, punctures and injections, with catheters, stomata, and if necessary with artificial respiration should be practiced. The guidelines of the German Commission on hospital hygiene and infection prevention should also be observed.
    No preview · Article · Dec 2015 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
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    ABSTRACT: Objectives: Multidrug resistant organisms (MDRO), including Meticillin-resistant Staphylococcus aureus (MRSA), and health care associated infections (HCAIs) are pressing issues for health care systems across the world. Information and communication are considered key tools for the prevention and management of infectious diseases. Public Health Authorities (PHA) are in a unique position to communicate with health care professionals, patients and the public regarding the health risks. Study design: We used PHA helpdesk interaction data to first ascertain the information requirements of those getting in contact with the service, and secondly to examine the communicative behaviour of the PHA, with a view to improving the quality of communication strategies. Methods: Data on helpdesk interactions between 2010 and 2012 were obtained from a MDRO network of nine German PHAs. 501 recordings were coded and descriptive statistics generated for further qualitative thematic analysis. Results: Our analysis revealed a similar pattern of questions among different groups. Key areas of need for information were around eradication, cleaning and isolation measures. Reported problems were a lack of expert knowledge and continuity of treatment. The helpdesk response was mainly a conversation offering scientific advice, but also included other communication services that went beyond the provision of scientific facts, such as follow-up calls, referral suggestions and consultations on behalf of the caller. These social communication activities seem to have an important impact on the acceptability of public health recommendations and use of the helpdesk. Conclusions: Our findings support a broader discussion about the role of information in the communication process and underline the importance of social elements in the communication process, such as relationship and trust building.
    No preview · Article · Dec 2015 · Public health
  • E. Jager · U. Heudorf
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    ABSTRACT: Considering the physiological contamination of skin and mucous membranes in the ear, nose, and throat region by facultative pathogen microorganisms, as well as the increase in multidrug resistant organisms (MDRO), it is mandatory that hygienic procedures be observed in ENT institutions, in order to prevent transmission of bacteria and infections in patients. General guidelines for hygiene in otorhinolaryngology are presented based on the recommendations published by the German Commission on Hospital Hygiene and Infection Prevention (KRINKO). These encompass hand hygiene, surface disinfection, and reprocessing of medical devices. The correct reprocessing of the various components of ENT treatment units (including endoscopes, water bearing systems) is reported. Although law requires and KRINKO recommends that manufacturers of medical devices publish instructions for reprocessing their products, these reprocessing recommendations are often insufficient. Manufacturers should thus be called upon to improve their recommendations. In this paper, the requirements for handling of ENT treatment units are compared with the observations made by the Public Health Department in 7 ENT clinics and 32 ENT practices in Frankfurt/Main, Germany, in 2014.
    No preview · Article · Nov 2015 · HNO
  • Ursel Heudorf
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    ABSTRACT: In URO-NEWS 7–8/2015 erschien die Fortbildung „Hygiene-Anforderungen in der Urologie“ von Prof. Ursel Heudorf und Dr. Eva Jager [1]. Aufgrund von Nachfragen zur Aufbereitung von Zystoskopen ergänzen und präzisieren die Autorinnen ihren Beitrag.
    No preview · Article · Nov 2015
  • U Heudorf · D Färber · D Mischler · M Schade · C Zinn · C Cuny · D Nillius · M Herrmann
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    ABSTRACT: Background: While a limited number of studies have investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in medical rehabilitation institutions, almost no data on the colonization of rehabilitation patients with multiresistant gram-negative rods is available. Here we report on a large multicenter study on the prevalence of MRSA and multiresistant pathogens in rehabilitation institutions in the Rhine-Main area in 2014. Materials and Methods: Altogether, 21 rehabilitation hospitals participated. For all patients, age, gender, previous history of hospitalizations, surgery, previous colonization with multidrug-resistant organisms, use of a medical device, current antimicrobial therapy, and the current infection status were ascertained. On voluntary basis, nare and throat swabs were taken for analysis of MRSA and rectal swabs were tested for extended spectrum betalactamase-producing gram-negative bacteria (ESBL). Results: 50% of 2 440 patients had a history of hospitalization within the previous 6 months while 39% had undergone surgery during the past 30 days. Approximately a quarter of the patients had been transferred to a rehabilitation hospital directly from an acute care hospital, had been under antimicrobial therapy with the past three months, or had travelled to a foreign country within the previous year. Risk factors such as lesions of the intact skin or presence of medical devices were rarely reported (< 5%) within the exception of patients undergoing geriatric or neurologic acute care rehabilitation. 0.7% (15/2155) of the patients were colonized with MRSA, while 7.7% (110/1434) showed a positive result for ESBL. The highest prevalence rates for multiresistant organisms were encountered among patients with neurologic rehabilitation (MRSA, 1.3%, and ESBL, 10.2%) or with geriatric rehabilitation (MRSA, 9.4%, and ESBL, 22.7%). Conclusion: In the rehabilitation patient population, the prevalence rates of MRSA and ESBL were found to be in the range of rates encountered in the general population (reported rates for MRSA, 0.5%, and ESBL, 6.3%). The known risk factors for MRSA such as skin lesions, medical devices and previous history for MRSA were also confirmed among this patient population. Direct transfer from an acute care hospital, antimicrobial treatment during the past 3 months, and wounds proved significant risk factors for ESBL colonization. Patients of neurologic rehabilitation and geriatric patients showed the highest rates of risk factors and the highest prevalence rates of multidrug-resistant organisms. It appears to be of importance for rehabilitation hospitals to be geared to the needs of patients with multidrug-resistant organisms, and prevent the transmission of these pathogens by appropriate hygiene measures.
    No preview · Article · Oct 2015 · Die Rehabilitation
  • N. Stergiou · M. Klump · B. Manus · A. Lewerth · D. Bobyk · U. Heudorf

    No preview · Article · Sep 2015 · Zeitschrift für Gerontologie + Geriatrie
  • 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.
    No preview · Article · Jul 2015 · Das Gesundheitswesen
  • 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.
    No preview · Article · Jul 2015 · Das Gesundheitswesen
  • M Hogardt · P Proba · D Mischler · C Cuny · V A Kempf · U Heudorf
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    ABSTRACT: Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge. © 2015, European Centre for Disease Prevention and Control (ECDC). All Rights Reserved.
    No preview · Article · Jul 2015 · Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin
  • M Schade · U Heudorf · P Tiarks-Jungk
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    ABSTRACT: Background: The humanitarian consultation-hour is a voluntary, anonymous offer provided by the City of Frankfurt am Main, which was established in December 2001. Here, people without health insurance or undocumented migrants can be treated for free. The aim of this analysis is to investigate the utilization of the consultation-hour by gender, age, country of origin and diagnosis since 2008. Methods: The digital data documentation is available since 2008. Data from the years 2008-2013 were considered. The examination date, the date of birth, sex, country of origin, frequency of visits, diseases and medication amongst other data were examined. Results: In the period from 2008 to 2013, 8 574 consultations were counted and 2 384 patients were treated during office hours. The amount of consultations has doubled between 2008 (n=673) and 2009 (n=1 154) and is rising steadily since then (1 911 visits in 2013). The majority of patients come from Africa. Since 2008, an increase of patients from Bulgaria and Romania has been recorded. Approximately two-thirds of the patients are female, one third male. One fifth of those seeking help are children and adolescents under 20 years and adults over 60 years. The most common age group is between 20-40 years old. The main diagnoses include diseases of the cardiovascular and vascular system and the musculoskeletal system, metabolic diseases (diabetes mellitus), digestive diseases and pregnancy/childbirth. Conclusion: The humanitarian consultation-hour is an important offer provided by the Public Health Department of the City of Frankfurt am Main and is used by a large number of people who are seeking help. In particular, people from South Eastern Europe are increasingly visiting the consultation-hour. Activities such as the humanitarian consultation-hour can take over subsidiary activities for a transitional period, however long-term structural solutions must be provided to ensure access to health care for this vulnerable group.
    No preview · Article · Jul 2015 · Das Gesundheitswesen
  • R. Woltering · G. Hoffmann · J. Isermann · U. Heudorf
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    ABSTRACT: Background and Objective: An assessment of cleaning and disinfection in hospitals by the use of objective surveillance and review of mandatory corrective measures was undertaken. Methods: A prospective examination of the cleaning and disinfection of surfaces scheduled for daily cleaning in 5 general care hospitals by use of an ultraviolet fluorescence targeting method (UVM) was performed, followed by structured educational and procedural interventions. The survey was conducted in hospital wards, operating theatres and intensive care units. Cleaning performance was measured by complete removal of UVM. Training courses and reinforced self-monitoring were implemented after the first evaluation. 6 months later, we repeated the assessment for confirmation of success. Results: The average cleaning performance was 34% (31/90) at base-line with significant differences between the 5 hospitals (11–67%). The best results were achieved in intensive care units (61%) and operating theatres (58%), the worst results in hospital wards (22%). The intervention significantly improved cleaning performance up to an average of 69% (65/94; +34.7%; 95% confidence interval (CI): 21.2–48.3; p<0.05), with differences between the hospitals (20–95%). The largest increase was achieved in hospital wards (+45%; CI 29.2–60.8; p<0.05). Improvements in operating theatres (+22.9%; CI 10.9–56.7) and intensive care units (+5.6%; CI 25.8–36.9) were statistically not significant. Conclusions: The monitoring of cleaning and disinfection of surfaces by fluorescence targeting is appropriate for evaluating hygiene regulations. An intervention can lead to a significant improvement of cleaning performance. As part of a strategy to improve infection control in hospitals, fluorescence targeting enables a simple inexpensive and effective surveillance of the cleaning performance and corrective measures.
    No preview · Article · Jun 2015 · Das Gesundheitswesen
  • 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.
    No preview · Article · Apr 2015 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
  • U Heudorf · A Hausemann

    No preview · Article · Apr 2015 · Das Gesundheitswesen
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    ABSTRACT: Background: Carbapenems are important therapeutic agents for treating infections caused by multidrug-resistant gram-negative bacteria. In November 2011, identification of gram-negative bacteria with acquired carbapenem resistance became notifiable in Hesse, Germany. Notification requirements were first based on results of antimicrobial susceptibility testing. Since April 2013 the definition of multidrug-resistance by the Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch-Institut was used. Only the so called 4MRGN isolates, which are resistant to the four major antibiotic classes acylureidopenicillins, third- and fourth-generation cephalosporins, carbapenems and fluoroquinolone are notifiable. At the same time notification requirements for Pseudomonas aeruginosa were restricted to isolates from blood and cerebrospinal liquid. Methods: We analyzed notifications received from 1 January 2012 through 30 September 2014, which fulfill the current notification requirements as of April 2013. Results: Between 1 January 2012 and 30 September 2014, 876 4MRGN were reported. Of these, 22 % (193) were Klebsiella pneumoniae, 21 % (185) Acinetobacter baumannii complex, 14 % (125) Citrobacter spp., 14 % (124) Escherichia coli, 12 % (104) Enterobacter spp., 7 % (62) P. aeruginosa and 4,6% (40) Klebsiella oxytoca. The 876 notifications were linked to 685 patients and 784 first notifications of a 4MRGN species for any given patient. 419 (48 %) isolates were reported to harbor a carbapenemase. Conclusion: 4MRGN are considered a threat to public health and therefore should be given high priority in the selection of notifiable conditions, e.g. notifiable pathogens. Reporting of 4MRGN is time-consuming and mandatory notification was introduced in Hesse although available resources are very scarce. At a national level, the introduction of mandatory notification for 4MRGN should be compensated by a corresponding reduction of already existing reporting requirements.
    No preview · Article · Jan 2015
  • U. Heudorf · A. Hausemann · M. Exner
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    ABSTRACT: In view of the frequent complaints about deficits in information transfer on multidrug-resistant organisms (MDRO) between inpatient and outpatient care, the revision of the German Infection Protection Act in 2011 stipulated that federal states were required to issue regulations on intersectoral information transfer. Although all of the 16 federal Regulations on Infection Control in Healthcare Institutions include the transfer of information from hospitals to primary care physicians, only 13 include emergency medical and ambulance services, and only four include ambulatory and inpatient care settings. Thus, for the most part, the objective of intersectoral information transfer has not yet been accomplished. All Regulations contain stipulations for information at the time when patients with MDRO are discharged or transferred. This is usually too late for the subsequent institutions to make the necessary preparations. There is only one state, which stipulates that information is to be provided before discharge and transfer. Four states refer to data protection when transferring information. When revising the Regulations, all relevant institutions (incl. nursing homes) should be incorporated and the timely information transfer previous to referral, admission or discharge has to be explicitly taken into account. Also, the Regulations should always encompass all MDRO which require hygiene precautions which go beyond the usual standard precautions (e.g. MRSA, 4MRGN). At the same time information transfer must not be disadvantageous for patients which need to be transferred or admitted to other institutions.
    No preview · Article · Jan 2015
  • E Jager · A Hausemann · H Hofmann · U Otto · U Heudorf
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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.
    No preview · Article · Dec 2014 · Zeitschrift für Gastroenterologie
  • 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.
    No preview · Article · Oct 2014 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
  • M Schade · U Heudorf · C Hornberg

    No preview · Article · Sep 2014 · Das Gesundheitswesen

Publication Stats

2k Citations
194.08 Total Impact Points

Institutions

  • 1995-2015
    • Gesundheitsamt Frankfurt
      Frankfurt, Hesse, Germany
  • 2014
    • University of Bayreuth
      • Institute for Medical Management and Health Sciences (IMG)
      Bayreuth, Bavaria, Germany
  • 2001-2013
    • Frankfurt City Public Health Office
      Frankfurt, Hesse, Germany
  • 2004-2009
    • University of Bonn
      • Institute for Hygiene and Public Health
      Bonn, North Rhine-Westphalia, Germany