Hygiene at the ISAR Clinic
What does hospital hygiene mean?
Today, hospital hygiene is a branch of hygiene that deals with the identification and investigation of all causes of harm to the health of patients, staff and the environment that occur in hospitals. The detection, prevention and control of hospital infections is of crucial importance for hospital hygiene.
The Public Health Service is responsible for monitoring hygiene conditions in hospitals and checking infection prevention measures. The legal basis for this is the Infection Protection Act (IfSG) and the state-specific hygiene regulations, in Bavaria the Bavarian Medical Hygiene Ordinance (MedHygV).
The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute (RKI) was established by Section 23 (1) of the Infection Protection Act. One of its tasks is to make recommendations on the prevention of nosocomial infections (i.e. infections caused by medical procedures) based on the current state of medical science.
In addition, there are numerous laws, regulations, directives, guidelines, recommendations and standards that must be observed when determining hygiene measures.
Everyone working in a hospital is jointly responsible for the implementation of hygiene measures. Only close cooperation between the various professional groups can help to prevent nosocomial infections.
From a legal perspective, the hospital management is responsible for implementing hygiene requirements. It is supported in this by hospital hygienists, doctors with responsibility for hygiene, hygiene specialists and hygiene officers in nursing. They meet regularly in the hygiene commission meeting, not only to exchange technical information on legal innovations, but also to discuss and decide on new hygiene standards or additions to old standards based on new findings. The decisions of this committee are binding for everyone.
A nosocomial infection is an infection that occurs in connection with a medical procedure, regardless of whether it was acquired on an outpatient or inpatient basis.
The mechanisms by which (nosocomial) infections arise are very complex and cannot always be prevented, but they can be reduced through consistent and appropriate measures, i.e. prevention. Nosocomial infections are rarely the result of “poor hospital hygiene”, as in most cases the pathogens detected are part of the patient’s skin or mucous membrane flora.
How is prevention applied at the ISAR Klinikum?
The prevention of nosocomial infections is a task that takes place on many levels. Success depends on the participation of all stakeholders in the medical act, as well as the involvement of all other professional groups working in the hospital.
And of course from your participation as a patient.
Hand disinfection plays a very important role in hospital hygiene and the prevention of nosocomial infections. Hand disinfection that is carried out correctly and in accordance with indications offers patients effective protection against acquiring nosocomial infections. It also helps to protect the person carrying out the procedure.
Improving compliance with hand disinfection in healthcare facilities throughout Germany is not only the aim of the “Clean Hands” campaign, but also the aim of our clinic. For this reason, the clinic’s participation in the campaign is a matter of course. And has done so since 2011.
Link to the campaign: www.aktion-sauberehaende.de/ueber-uns-ash
What can you do to support this simple yet effective measure, increase compliance with hand disinfection and implicitly protect yourself? We have briefly explained this in the brochure “Hand hygiene can save lives”.
Screening is generally defined as the active and targeted search for MRE-colonized persons (so-called carriers) regardless of clinical symptoms.
Based on the results of the screening carried out, hygiene measures are introduced to minimize the risk of a nosocomial infection. At the same time, targeted measures can be taken to prevent transmission to other patients and/or staff.
Multi-resistant pathogens (MRE) are bacteria that have become resistant to the effects of various antibiotics. In the event of an infection, this means, among other things, more limited treatment options for those affected. For this reason, screening plays an important role as a pillar of prevention in the development of nosocomial infections.
Methicilin-sensitive Staphylococcus aureus (MSSA) is typically found on the skin and/or mucous membranes of many healthy people without the carrier knowing or realizing it. Infections caused by Staphylococcus aureus can usually be treated well.
Methicillin-resistant Staphylococcus aureus is the name given to a bacterium that has become insensitive (resistant) to a specific group of antibiotics. These bacteria are also not noticeable on the skin or mucous membranes of healthy carriers. It is therefore all the more important that we “discover” them before an operation (through screening) and try to “eliminate” them from the skin and mucous membrane. The attempt at elimination is called sanitation or decolonization and involves a series of measures that are carried out by the (outpatient) patient.
Why is MRSA decontamination important?
According to studies, people colonized with MRSA have a 4-fold higher risk of developing postoperative infections compared to those colonized with MSSA. Other studies have shown that infections with MRSA are associated with an increased mortality rate compared to infections with MSSA.
What can you contribute to MRSA screening?
The standardized questionnaire can be used to determine whether you have an increased risk of MRSA colonization. This is asked before admission to hospital. Answer it honestly. You can assess your risk yourself here here.
If you have been identified as a MRSA risk patient on the basis of the interview, you will be tested for the presence of MRSA using a swab from your nose. If the test is negative, there is nothing to prevent you from being admitted to hospital. If the test is positive, outpatient MRSA treatment will be initiated.
The results of swabs brought to the hospital which are not older than 4 weeks prior to admission are accepted (e.g. a swab taken by the family doctor).
How does MRSA decontamination work?
You will be informed of the positive result by your surgeon/therapist.
The products for the sanitation measures will then be handed out to you free of charge by the clinic during a personal consultation. You will be accompanied during the outpatient sanitization, i.e. the hygiene specialist will be at your side as a contact person. All necessary control swabs after completion of the sanitation measures will be taken in the clinic’s pre-medication outpatient clinic. There are no extra costs for you – this service is unique.
Different procedures are possible depending on the place of residence and/or health condition.
You can find out more about the refurbishment process here for more information.
Most representatives of these bacterial groups are intestinal germs, but some can also be found on the skin or in the nasopharynx. Sanitation similar to MRSA sanitation is not possible and is not recommended.
The clinic carries out MRGN and VRE screening for all patients who require planned post-operative treatment in the intensive care unit. The risk criteria defined by the Hygiene Commission in consultation with the Munich Health Department and on the basis of KRINKO recommendations enable the hospital to immediately implement measures to prevent the transmission of pathogens.
The ISAR Klinikum has been using the Hospital Infection Surveillance System, KISS for short, for many years to prevent the frequency of infections and to ensure internal quality standards. The method developed by the National Reference Center for Surveillance of Nosocomial Infections (NRZ) helps with the continuous monitoring of hospital infections and, with its uniform standards, enables comparability between the individual wards and departments.
As post-operative wound infections are the third most common type of hospital infection, the ISAR Clinic relies on the OP-KISS module for monitoring. The decision was made to use two types of surgery as indicator surgeries for the evaluation: Surveillance of wound infections after knee endoprosthesis (initial implantation) and after prostatectomy.
Since 2012, the ISAR Klinikum has also been participating in the HAND-KISS module, which records the consumption of hand disinfectant within the wards or functional areas. In addition, ISAR Klinikum has been using the MRSA-KISS module since 2014 to record MRSA cases at the hospital.
Link to the KISS homepage www.nrz-hygiene.de/surveillance/kiss/
Here, too, you can help to reduce the risk of postoperative wound infection.
For patients who have an indication for a prosthesis implantation or revision and have decided to have the operation at the ISAR Clinic, we provide antiseptic body wipes free of charge. We recommend using these wipes the evening before the planned operation and on the day of the operation. Your surgeon will explain this to you as part of the surgical briefing.
Here you can find more information about antibiotic stewardship at ISAR Klinikum.
Microscopic lesions in the skin caused by shaving are entry points for bacteria, which can be responsible for the development of a post-operative wound infection. It is therefore important that you refrain from shaving your hair yourself before the operation. If shaving is necessary, it will be carried out by specialist staff in the clinic before the planned operation.