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Hospital hygiene is a task that needs to be addressed every day across all of our wards and all other areas of the hospital. In addition to protocols outlining regular cleaning and disinfection procedures, Charité has its own dedicated institute, which is responsible for implementing infection prevention and control measures – the Institute of Hygiene and Environmental Medicine. “We are responsible for all of Charité's campuses,” explains the Head of the Institute, Prof. Dr. Petra Gastmeier, adding that “every campus also has its own hospital hygiene team, which consists of the Senior Physician with a remit for this area, junior physicians, and hospital hygiene experts.”
Berlin's Hygiene Regulations stipulate that all members of staff have to take part in infection prevention and control training once a year. In addition to this, each Department has a nominated member of staff with a remit for infection control. These 'infection control advisors' effectively act as a link between the Institute's experts, and members of staff within the various departments and wards. “Our infection control advisors are an important point of contact within the different areas of the hospital, as they can respond to specific questions, or provide more detailed advice where this is necessary,” adds Dr. Petra Gastmeier. The Institute of Hygiene and Environmental Medicine has its own hospital hygiene laboratory, which tests close to 100,000 samples for multidrug-resistant organisms every year. “We are also involved in the training of medical students, to ensure that the next generation of physicians are familiar with the current standards,” explains the Head of the Institute. New members of staff have to attend a training session that aims to provide an introduction to the main aspects of infection prevention and control.
The majority of hospital pathogens are transmitted via our fingers and hands. This is why our members of staff have to comply with the guidelines on hand hygiene in health care, which were issued by the WHO in 2005:
When is it necessary for nursing and medical staff to use an antiseptic agent to clean their hands?
- Before having direct contact with a patient
- Before any clean or aseptic procedure
- After direct contact with potentially infectious material (e.g. body fluids, blood, secretions,
- After direct contact with a patient
- After leaving the patient's side/(immediate) vicinity
Naturally, hands must be washed whenever they are visibly dirty. Washing alone, however, is not sufficient. Hand antisepsis can only be achieved through use of a hand sanitizer and compliance with hand hygiene techniques. The use of single-use gloves does not replace the need for suitable hand hygiene. Gloves should be used in situations where it is likely that contact with potentially infectious materials will occur. For all of Charité's wards, we have been recording the amount of hand sanitizer used per patient per day since 2007. In 2014, intensive care wards used an average of 194ml per patient per day, while normal wards used an average of 41ml. In 2013, in recognition of its commitment to improving hand hygiene, Charité was recognized as a 'Global Hand Hygiene Expert Centre' by WHO.
The majority of pathogens are not airborne
Approximately 90% of pathogens found inside hospitals are not airborne, i.e. they are not transmitted through the air, but through direct or indirect contact with contaminated hands, items or surfaces. These include diarrhea-causing pathogens as well as the vast majority of multidrug-resistant organisms. As a result, compliance with appropriate hand hygiene measures is essential.
Approximately 8% of pathogens are transmitted through coughing and sneezing. This includes the majority of organisms responsible for respiratory tract infections (e.g. influenza or other viral infections), but also includes those associated with common childhood diseases (such as rubella or mumps). The best way to avoid this type of infection is to keep a safe distance; the recommended safe distance is set at over one meter. For close contact with an infected patient, a suitable face mask covering the nose and mouth should be worn.
Only approximately 2% of all airborne pathogens are able to spread beyond this safe distance (e.g. the pathogens responsible for tuberculosis, measles, and chickenpox). When dealing with this type of pathogen, members of staff should wear a well-fitting face mask specifically indicated for this purpose – unless the member of staff has naturally acquired immunity or has been vaccinated against the disease. Patients with this type of disease should be segregated in a single room.
Where exactly do germs, viruses and bacteria come from?
Every patient who is admitted to the hospital is a carrier of microorganisms that could cause infections. The microorganisms that colonize the human body are also referred to as the human microbiome. Millions of bacteria and other microorganisms reside within our skin and mucous membranes. The majority of these are found inside the bowel, and the total microbiome can account for a total of up to 2kg of a person's body weight. These bacteria play a very important role in our digestion, metabolism, and immune systems. However, they can become a serious problem when they enter areas of the body that are normally aseptic, such as the bladder, the lungs, or the blood, where they can cause bladder infections, pneumonia, or sepsis. While in hospital, many patients will need to undergo procedures that involve the insertion of a medical device into the body, such as urinary catheterization or the insertion of a venous catheter. All such invasive procedures are associated with a risk of bacteria from the patient's own body contaminating normally aseptic areas of the body, thus causing infections. Furthermore, patients whose immunity is impaired as a result of certain types of medication or as a result of treatments such as chemotherapy are more prone to this type of infection.
In short, the more seriously ill a patient is, the more likely they are to represent and infection risk for the hospital. Patients who develop this type of infection are said to have a hospital-acquired infection. Strict adherence to infection control measures is crucial in order to minimize the risk of infections. Handwashing alone is not sufficient! Please act responsibly, and follow the rules and techniques of proper hand hygiene displayed throughout the hospital.