Markus Dettenkofer's research while affiliated with Universitätsklinikum Schleswig - Holstein and other places

Publications (230)

Article
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Introduction: Training in hand hygiene for health care workers is essential to reduce hospital-acquired infections. Unfortunately, training in this competency may be perceived as tedious, time-consuming, and expendable. In preceding studies, our working group detected overconfidence effects in the self-assessment of hand hygiene competencies. Overc...
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Abstract Introduction Multi-drug-resistant organisms (MDRO) are usually managed by separating the infected patients to protect others from colonization and infection. Isolation precautions are associated with negative experiences by patients and their relatives, while hospital staff experience a heavier workload and their own emotional reactions....
Chapter
Eine nosokomiale Infektion (griech. „nosokomeíon“, Krankenhaus) ist laut Infektionsschutzgesetz definiert als eine „Infektion mit lokalen oder systemischen Infektionszeichen als Reaktion auf das Vorhandensein von Erregern oder ihrer Toxine, die im zeitlichen Zusammenhang mit einer stationären oder einer ambulanten medizinischen Maßnahme steht, sowe...
Article
The Failure-Mode-Effect-Analysis (FMEA) is well accepted for individual and institutional learning in industrial and economic risk management. The medical version is suitable for seminars of 4 to 10 experienced pre- and postgraduate multiprofessional health care providers. These have to be familiar with a common structured medical process (e.g. blo...
Article
Background: Bloodstream infection (BSI) remains a serious complication in patients with hematologic malignancies and neutropenia. The risk factors for mortality after BSI and the contributions of BSI pathogens to mortality remain incompletely understood. Methods: We evaluated first BSI among adult neutropenic patients undergoing high-dose chemot...
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Purpose The length of neutropenia has a significant impact on the incidence of bloodstream infection (BSI) in cancer patients, but limited information is available about the pathogen distribution in late BSI. Methods Between 2002 and 2014, BSI episodes in patients with neutropenia receiving chemotherapy for hematologic malignancies were prospectiv...
Article
To evaluate learning motivation barriers in infection control and feedback competences, we conducted a national online survey in Germany. Among 767 healthcare workers, overconfidence effects could be detected independent from age, gender, profession, education, and hospital-size. The identified effects may impair learning motivation relevant for su...
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Background: Hospital-acquired infections have not only gained increasing attention clinically, but also methodologically, as a time-varying exposure. While methods to appropriately estimate extra length of stay (LOS) have been established and are increasingly used in the literature, proper estimation of cost figures has lagged behind. Methods: A...
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Schulungen sind zentrale Elemente der Infektionsprävention und der Arbeit von Krankenhaushygienikern und Hygienefachkräften. Dieser Beitrag vergleicht zunächst ausgewählte Curricula der Aus-, Fort- und Weiterbildung verschiedener medizinischer Fachberufe. Danach wird der Risikomanagement-Prozess nach ISO 31000 beispielhaft für eine Händehygieneschu...
Article
BACKGROUND: Hospital-acquired infections caused by multidrug-resistant organisms (MDROs) are a threat to patient safety and hospital economy. Training in hygiene precautions is known to limit MDRO spread and patient morbidity. As infection prevention is a collaborative task, we developed an interprofessional educational intervention, including a re...
Book
In dem vorliegenden Werk beschreiben ausgewiesene Experten, welche diagnostischen und allgemeinen therapeutischen Maßnahmen bei Infektionen mit multiresistenten Erregern sinnvoll und erfolgsversprechend sind. Das Werk wendet sich an alle Ärzte in allen Einrichtungen des Gesundheitswesen, die Patienten mit Infektionen durch multiresistente Erreger b...
Article
Background Infection control partially depends on hygiene and communication skills. Unfortunately, motivation for continuous training is lower than desired. Many health care providers (HCPs) do not recognize the need for training but express this need for others. This is attributable to heuristic errors, such as the overconfidence effect. The aim o...
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Background: Definitions and practices regarding use of contact precautions and isolation to prevent the spread of gram-positive and gram-negative multidrug-resistant organisms (MDRO) are not uniform. Methods: We conducted an on-site survey during the European Congress on Clinical Microbiology and Infectious Diseases 2014 to assess specific detai...
Article
Objectives: Antibacterial chemoprophylaxis with fluoroquinolones (FQPx) has been commonly used in cancer patients with neutropenia, but its efficacy has been challenged by the emergence of fluoroquinolone resistance. Methods: The impact of FQPx on bloodstream infections (BSI) during neutropenia after high-dose chemotherapy for haematologic malig...
Chapter
Neben der Entfernung von sichtbaren Verschmutzungen und nicht unbedingt sichtbaren potenziell infektiösen Kontaminationen beinhaltet die Hausreinigung eine ganze Reihe weiterer Aspekte, die gern vergessen oder unterschätzt werden. Reinigung oder Desinfektion sollen zwar wirksam, aber nicht schädlich sein: Die Gesundheit von Personal und Patienten d...
Chapter
Die aktuellen Leitlinien zu MRSA basieren auf einer mangelhaften Datenlage und haben eine entsprechend geringe Evidenz; einige Empfehlungen sind sehr praxisfern und daher schwer vermittelbar. Aufgrund der Komplexität der offiziellen Empfehlungen gewinnen horizontale Infektionspräventionsansätze wie die konsequente Durchführung der Händehygiene inkl...
Chapter
Eine Suppression des Immunsystems ist entweder durch eine Erkrankung oder durch ärztliche Intervention bedingt. Immunsupprimierte Patienten präsentieren sich nicht als homogene Gruppe, vielmehr wirken immunmodulierende Einflüsse im Rahmen verschiedener Erkrankungen und Therapien in ganz unterschiedlichem Maße auf die zahlreichen Effektoren und Mech...
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Krankenhaushygienische Umgebungsuntersuchungen im Labor sind teilweise routinemäßig und zum anderen Teil nur in besonderen Situationen (z. B. Infektionsausbruch) erforderlich. Da hierfür neben den üblichen mikrobiologischen Methoden aber auch andere Untersuchungsgänge anfallen, soll hier eine Übersicht über diese speziellen Methoden mit praktischen...
Chapter
Für eine hohe Patientensicherheit ist gerade angesichts weltweit kritischer Entwicklungen (wie bei Resistenzen) eine aktive und gut organisierte Krankenhaushygiene essentiell. Mit den in diesem Kapitel dargestellten, weitgehend verbindlichen Vorgaben zur organisatorischen und personellen Ausgestaltung effektiver krankenhaushygienischer Teams wurden...
Book
Professionelle Infektionsprävention und praxisnahe Hygiene Von Händedesinfektion bis Baumaßnahmen Standard-Hygienemaßnahmen bei der Patientenversorgung und für den Personalschutz, technische Hygiene (Luft, Wasser), sichere Abfallentsorgung und wirksame Hausreinigung. Von konservativ bis operativ Desinfektion und Antisepsis in Ambulanz, Station, In...
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Objectives: Hand hygiene is considered the most effective way to reduce the transmission of (multidrug-resistant) organisms and to prevent healthcare-associated infections. Hand rubbing with alcohol-based handrub (AHR) has become the gold standard for hand hygiene. Data on AHR consumption are easy to obtain and can serve as an approximation for ha...
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Objectives Antibacterial resistance is emerging in patients undergoing haematopoietic stem cell transplantation (HSCT), and most data on the epidemiology of bloodstream infections (BSI)-causing pathogens come from retrospective single-centre studies. This study sought to investigate trends in the epidemiology of BSI in HSCT patients from a prospect...
Chapter
Neben der Entfernung von sichtbaren Verschmutzungen und nicht unbedingt sichtbaren potenziell infektiösen Kontaminationen beinhaltet die Hausreinigung eine ganze Reihe weiterer Aspekte, die gern vergessen oder unterschätzt werden. Reinigung oder Desinfektion sollen zwar wirksam, aber nicht schädlich sein: Die Gesundheit von Personal und Patienten d...
Chapter
Die aktuellen Leitlinien zu MRSA basieren auf einer mangelhaften Datenlage und haben eine entsprechend geringe Evidenz; einige Empfehlungen sind sehr praxisfern und daher schwer vermittelbar. Aufgrund der Komplexität der offiziellen Empfehlungen gewinnen horizontale Infektionspräventionsansätze wie die konsequente Durchführung der Händehygiene inkl...
Article
Full-text available
Purpose Prevention and control of healthcare-associated infection (HCAI) are important within and beyond Europe. However, it is unclear which areas are considered important by HCAI prevention and control professionals. This study assesses the priorities in the prevention and control of HCAI as judged by experts in the field. Methods A survey was co...
Article
In this prospective cohort study, 200 decontamination (cleaning and disinfection) procedures of the anesthesia workplace either by anesthesia nurses or by specially trained housekeeping staff were monitored. Time used by housekeeping staff was shorter (1.2 +/- 0.1 vs 2.6 +/- 0.2 minutes on average, data are mean +/- SEM; P < 0.0001) with less visib...
Chapter
Für eine hohe Patientensicherheit ist gerade angesichts weltweit kritischer Entwicklungen (wie bei Resistenzen) eine aktive und gut organisierte Krankenhaushygiene essentiell. Mit den in diesem Kapitel dargestellten, weitgehend verbindlichen Vorgaben zur organisatorischen und personellen Ausgestaltung effektiver krankenhaushygienischer Teams wurden...
Book
In dem vorliegenden Werk beschreiben ausgewiesene Experten, welche diagnostischen und allgemeinen therapeutischen Maßnahmen bei Infektionen mit multiresistenten Erregern durchgeführt werden sollten und welche Strategien erfolgversprechend sind. Daneben wird auf die Mechanismen der Resistenzentwicklung gegen Antibiotika eingegangen und wie sich dies...
Article
Full-text available
Background The hands of the medical staff play an important role in transmission of pathogens in the health care environment. Hand hygiene is efficient, easy to perform and cost-effective. Safety, tolerability and acceptance of hand hygiene preparations play a major role in hand hygiene compliance, and apply, in particular, to formulations with hig...
Article
Objective: To describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). Method: The epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight in...
Article
Background: Nosocomial influenza is increasingly recognized as an important public health threat causing considerable morbidity and mortality each year. However, data on nosocomial influenza is usually collected during outbreaks only and clinical information of nosocomial influenza is sparsely available. Objectives: To systematically analyse the di...
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Although the prevalence of carbapenemase-producing Acinetobacter baumannii (CP-AB) in Germany is still low an increasing number of outbreaks has been reported in recent years. In August 2014 we observed a cluster of 4 patients with CP-AB (OXA-23) on our surgical intensive care unit (SICU).
Chapter
Eine nosokomiale Infektion (griechisch: nosokomeíon = Krankenhaus) ist laut Infektionsschutzgesetz definiert als eine „Infektion mit lokalen oder systemischen Infektionszeichen als Reaktion auf das Vorhandensein von Erregern oder ihrer Toxine, die im zeitlichen Zusammenhang mit einer stationären oder einer ambulanten medizinischen Maßnahme steht, s...
Article
Despite control efforts, the burden of health-care-associated infections in Europe is high and leads to around 37 000 deaths each year. We did a systematic review to identify crucial elements for the organisation of effective infection-prevention programmes in hospitals and key components for implementation of monitoring. 92 studies published from...
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Einleitung Die Prävention und Kontrolle von nosokomialen Infektionen und multiresistenten Pathogenen ist von größter Wichtigkeit für einen hohen Level an Patientensicherheit. Unterstützt durch jüngst erlassene Rechtsvorschriften wurden in Deutschland vor kurzem besser koordinierte Programme eingeführt. Gut ausgebildetes und hoch motiviertes Persona...
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Background Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention. Aim To overview of current national European guidelines for C. difficile infection (CDI) prevention and reviews the recommendations in respect of their evidence base and conformity to each other and the European...
Article
Lebensmittelinfektionen zahlen nach wie vor zu den haufigsten durch Mikroorganismen verursachten Erkrankungen. Selbst verursachte Erkrankungen gehen vor allem auf einfache Handhabungsfehler mit Lebensmitteln zuruck. Wichtigste Ursachen sind zu lange Aufbewahrung bis zum Verzehr, unzureichende Kuhlung und/oder unzureichendes Erhitzen, fehlende Trenn...
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Introduction: In recent years, hygiene requirements for medical practices in Germany have been growing steadily. The background for this is the equalisation of process-related hygiene standards between inpatient and outpatient facilities. Discussion: The situation is difficult regarding uniform nationwide requirements and there is a relative lack o...
Article
Background: There is increasing interest in public reporting of healthcare-associated infection (HAI) data in Europe, mostly for patient safety reasons. But it is uncertain whether patients and other stakeholders benefit from them. Aim: To obtain the views of European infection control opinion leaders and provide information about public reporti...
Article
Surveillance of nosocomial infections is meanwhile a cornerstone of infection prevention activities in hospitals. The objective of this article is to compare healthcare-associated infection rates in intensive care patients, neonatal intensive care patients and operated patients (ICU-KISS, OP-KISS, NEO-KISS) of the German nosocomial infection survei...
Article
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SUMMARYChemotherapy and/or radiotherapy used as conditioning regimens before autologous or allogeneic haematopoietic cell transplantations (HCTs) cause neutropenia, which is the main reason for bloodstream infections. Autologous HCTs are considered to be superior to allogeneic HCTs in terms of infection outcome. A previous analysis suggested that p...
Article
Under the subheading “Hygienic measures in clinical practice”, the authors rightly point out the crucial importance of proper hand hygiene. It is not correct, however, that exclusively “virucidal” disinfectants can be used. Rapid, 30-second effectiveness against adenoviruses is sufficient, as is possible by using one of several commercially availab...
Article
Full-text available
The hands of the medical staff play an important role in transmission of pathogens in the health care environment. Hand hygiene is efficient, easy to perform and cost-effective. Safety, tolerability and acceptance of hand hygiene preparations play a major role in hand hygiene compliance, and apply, in particular, to formulations with high anti-vira...
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Full-text available
The European Commission (FP-7) funded project PROHIBIT (Prevention of Hospital Infections by Intervention and Training) was established in 2010. WP2 of PROHIBIT aims to analyse existing national guidelines, practices in surveillance and public reporting of healthcare associated infections (HAI) in Europe.
Article
Providing surgical treatment for patients colonised or infected with multidrug resistant organisms (MDROs) is daily routine in German hospitals. However, there is uncertainty about the application of adequate infection control measures in the OR. One of the reasons is that specific guidelines are not available. We evaluated current practice in surg...
Article
A time-series analysis was performed to identify the impact of bed occupancy rates and length of hospital stay on the incidence of Clostridium difficile infections (CDI). Between January 2003 and July 2008, a mean incidence of 0·5 CDI cases/1000 patient days was recorded. Application of a multivariate model (R2=0·50) showed that bed occupancy rates...
Article
Die Verbreitung von Methicillin-resistenten Staphylococcus-aureus-Stammen (MRSA) stellt ein relevantes Qualitatsproblem fur die stationare Patientenversorgung dar. Masnahmen zur Kontrolle der Resistenzausbreitung erfordern zusatzliche finanzielle und personelle Ressourcen. Die hygienische Handedesinfektion mit einem alkoholischen Praparat reduziert...
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A symposium was held in June 2009 near Freiburg in Germany. Twenty-nine attendees from several European countries participated, most of whom are actively involved in research and hospital infection prevention and control. The following topics were presented and discussed: isolation and screening for control of multidrug-resistant organisms; impact...
Chapter
Die Hauptursachen für die überdurchschnittliche Häufigkeit von Krankenhausinfektionen (nosokomiale Infektionen; ▸ Kap. 64) auf Intensivstationen sind nicht Hygienefehler, sondern die erhöhte Disposition: Die Patienten sind empfänglich durch verschiedene Grundkrankheiten, operative Eingriffe usw. und die erhöhte Keimexposition durch invasive diagnos...
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Skin colonisation is an important source for central venous catheter (CVC) colonisation and infection. This study intended to identify risk factors for skin colonisation prior to CVC placement (baseline colonisation) and within 10 days after CVC insertion (subsequent colonisation), for CVC-tip colonisation and for bloodstream infection (BSI). Withi...
Article
Epidemiologists often study the incidence density (ID; also known as incidence rate), which is the number of observed events divided by population-time at risk. Its computational simplicity makes it attractive in applications, but a common concern is that the ID is misleading if the underlying hazard is not constant in time. Another difficulty aris...
Article
Two multivariate time-series analyses were carried out to identify the impact of bed occupancy rates, turnover intervals and the average length of hospital stay on the spread of multidrug-resistant bacteria in a teaching hospital. Epidemiological data on the incidences of meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-...
Article
The transmission of multidrug-resistant organisms (MRSA, VRE and ESBL producing bacteria) occurs predominantly if health-care workers are not compliant with hand hygiene procedures. The impact of single-room isolation in transmission prevention is often overestimated. As long as hand disinfection is not performed before and after patient contact an...
Article
Zusammenfassung Multiresistente Erreger (MRE) nehmen weltweit zu. Die häufigsten MRE sind methicillinresistente S. aureus, gefolgt von vancomycinresistenten Enterokokken und ESBL (Extended-Spectrum β-Lactamase)-bildenden Erregern. Letztere spielen in der Augenheilkunde bisher keine große Rolle. MRE können schwere Infektionen verursachen und sind be...
Article
The transmission of multidrug-resistant organ-isms (MRSA, VRE and ESBL producing bacteria) occurs predominantly if health-care workers are not compliant with hand hygiene procedures. The impact of single-room isolation in transmis-sion prevention is often overestimated. As long as hand disinfection is not performed before and after patient contact...
Article
We tested the impact of short hand hygiene training sessions and bed occupancy rates on the spread of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a multivariate time-series analysis. According to our model, bed occupancy rates within general ward and intensive care unit settings correlated positively with the incidenc...
Article
The objective of this case-control study was to investigate the source of contamination and risk factors for colonisation and infection during an outbreak of extended-spectrum beta-lactamase (ESBL)-producing Enterobacter cloacae in the University Medical Center Freiburg. A risk factor analysis was performed on 23 patients with ESBL-producing E. clo...
Article
Multidrug-resistant organisms (MROs) are increasing all over the world. The most important MROs are methicillin-resistant S. aureus, followed by vancomycin-resistant enterococci and extended-spectrum beta-lactamase (ESBL)-producing bacteria. The latter are not yet of much importance in ophthalmology. MROs can cause serious infections and must be co...
Article
Multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) und extended-spectrum β-lactamase (ESBL-) producing bacteria are an ever-expanding challenge regarding infection control and prevention strategies also in ambulatory healthcare settings. The most important transmi...
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The discovery that disinfecting hands reduces transmission of pathogens is a cornerstone of modern medicine and a crucial quality parameter in the healthcare system. Improving hand hygiene is obligatory for all institutions. We therefore are at a loss to understand why many parties in Germany have chosen not to participate in the national clean han...
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During the last years an increase in the antibiotic resistance of enterobacteriaceae has been observed. This increase does not only consist of an increase of the number of enterobacteriaceae resistant to 3rd generation cephalosporines but also the combination of resistance to 3 rd generation cephalosporines with resistance to quinolones and in some...
Article
Multidrug-resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) und extended-spectrum beta-lactamase (ESBL-) producing bacteria are an ever-expanding challenge regarding infection control and prevention strategies also in ambulatory healthcare settings. The most important tran...