What's the Worst New Hospital Infection

Hospital infection: Every day is a fight against the germs


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The door to room two is closed, behind it a young man is fighting for his life. It's been two years since he got new lungs. Now they are threatening to fail. Only those who absolutely have to go inside. Before they enter the anteroom, doctors and nurses in intensive care unit 144i at the Berlin Charité clean their shoes on a disinfection mat. In the lock they disinfect their hands, put on disposable gowns and plastic gloves, and finally a face mask, hood and shoe covers. On the way out, do the same thing in reverse.

The hygiene routine is intended to protect the other patients in the ward. Because the 31-year-old carries a dangerous germ in his respiratory tract that is not allowed to escape from the room: a multi-resistant variant of the bacterium Acinetobacter baumannii . "We already knew this before the patient was transferred to us and immediately isolated him," says senior physician Alexander Uhrig. Only one antibiotic can keep the pathogen in check: colistin. It has hardly been used for 50 years because it damages kidneys and nerves.
Acinetobacter baumannii is new among the hospital germs, ten years ago it was first observed in field hospitals in Iraq and Iran. Now the stubborn germ is arriving in Europe. It can survive for months on doorknobs, medical equipment or bedside tables. And he's not alone: Staphylococcus aureus , Klebsiella pneumoniae or Pseudomonas aerguinosa are other bacteria that repeatedly lead to disease outbreaks in clinics. Then there are headlines in the newspapers again and the guilty party is sought: whether in Bremen, Leipzig or most recently in Berlin.

Hygiene hysteria?

Franz Daschner, an expert in hospital hygiene, is annoyed by the "hygiene hysteria" in the German press. Every hospital infection is scandalized, he criticized a few weeks ago in a speech in Berlin. "Only 30 percent of all hospital infections are preventable, the rest are fateful," says Daschner.

"It shouldn't be about guilt, but about clearing up the causes," says Uhrig. He knows that with a little bad luck, the next headlines could be for his station. Because the 144i with its 18 beds is not a normal intensive care unit. On the one hand, she specializes in serious infectious diseases such as pneumonia, blood poisoning and tuberculosis. 70 to 80 percent of the patients who come here bring a hospital germ with them, much more than anywhere else.



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In addition, seriously ill people who have been ventilated for weeks learn how to cope without mechanical ventilation again. It often takes months before they can breathe in on their own again. And with every week the risk of unwanted infection increases. "Experience has shown that people with such seriously ill people experience a problem every 14 days," says Norbert Suttorp, Director of the Clinic for Infectiology and Pneumology.

The probability that a patient will be harmed can be reduced, says Uhrig. However, there is no such thing as 100 percent security. Even minor awkwardnesses allow microbes to migrate from bed to bed and settle on the next patient's skin. "The expectations of medicine are enormous. At the same time, politics requires us to write a black zero. Better and cheaper. How is that supposed to work?"

Cost pressure determines the framework

Uhrig would prefer to have the lung patient in room two only taken care of by certain doctors and nurses: "But the personnel situation does not allow for that." The cost pressure in the hospital creates framework conditions under which employees reach their limits: Because narrow three-bed rooms in an intensive care unit do not meet international standards, because there is a lack of staff and the work density increases, because even gowns and gloves should be as inexpensive as possible.

The fact that a bacterium is passed on does not always lead to problems. There are ten times more microbes than cells in and on every human body. With every handshake, with every hug, some of them are exchanged. As long as they stay where they belong, they are not a threat. But anyone who is in an intensive care unit depends on a number of tubes: on a urinary catheter to drain the urine or a venous catheter to get drugs or electrolytes efficiently into the blood. The same expressway can take its own and foreign germs, in the worst case they cause blood poisoning. The sicker the patient, the longer they need catheters and the more they have to be handled, the greater the risk.

Infection can also arise because a doctor wants to avoid complications such as stomach bleeding. For example, if you lower the acidity of gastric juice, the wrong germs can settle there. When they get into the lungs through the mouth and throat, they cause pneumonia.