Historic increase in number of infection control practitioners in German hospitals-is it enough?

Germany‘s public health insurer is reporting that hospitals and clinics are hiring more hygiene staff. This trend is primarily due to new funding made available through national health insurance funds. Even with these new measures, is there still a need for improvement?

Infection control practitioners (ICPs) are the contact people for questions relating to infection prevention in hospitals. Their responsbilities include preventing, identifying, and monitoring nosocomial (hospital-acquired) infections. These specialists have a special role to play – especially in light of the the up to 600,000 hospital infections that occur yearly in Germany, leading to as many as 20,000 deaths. Due to the rise of multi-resistant pathogens and persistence of outbreaks and pandemics such as Covid-19, the role of these specialists has gained increased focus.

The increase of ICPs in Germany is at least partially the result of new hygiene regulations, the Infection Protection Act (IfSG), that came into effect in 2011. These guidelines specified the need for hygiene specialists based on the number of beds and risk classification of individual facilities. [2] According to the regulation, the following ratios must be met:

• High risk (A): 1 infection control practitioner per 100 beds.
• Medium risk (B): 1 infection control practitioner per 200 beds
• Low risk (C): 1 infection control practitioner per 500 beds

Category A mainly includes intensive care units and inpatient areas with immunosuppressed patients, whereas a lower risk of infection can be assumed in rehabilitation facilities or psychiatric wards and the need for hygiene specialists is comparatively low.

Support program for hiring Infection control practitioners takes effect

After the passage of these new regulations, a financial support program was launched by the national health insurance fund. This program helped medical facilities meet the requirements of the IfSG.

In 2012 – shortly before the initiative was launched – the number of inpatient hygiene specialists in Germany was 1338, and about 40 percent of all hospitals had at least one hygiene specialist on staff. [3]

By the end of 2019, there were 2,539 infection control practitioners working in German hospitals-almost double the number in 2012. [5] This is one of the ways that the funding program had a large impact on German healthcare. According to a report by the national health insurance program, hospitals were provided with nearly €430 million to improve hygiene staffing during the funding period (2013-2019). More than 1,100 facilities benefited from the additional funding. A majority of the funds – more than 300 million euros – was used to recruit new hygiene staff, fill newly created positions internally, and increase the number of existing positions on a part-time basis. [4]

During the funding period, the hospitals used almost 50 million euros for training and continuing education for hygiene specialists and others.

The latest data from the German Federal Statistical Office, published in March 2021, show the quantitative impact of the funds used on the number of infection control practitioners.

Despite this positive development, some hygiene experts continue to see a shortage of personnel in hospital hygiene – especially when considering cleaning staff and the nursing shortage. Having enough time for practicing hygiene in the ward before, during, and after caring for patients is crucial to the success of any hygiene program.

Hygiene remains an essential topic for the future of healthcare

The pandemic has made it clear how important a functioning hygiene infrastructure is for hospitals. Good hygiene programs includes, first and foremost, well-trained staff, but also include organizational and structural shifts. The hygiene specialist plays an important role in the hygiene team, which also includes a hospital hygienist and hygiene-responsible physicians, who work together to ensure patient protection.

We will continue to depend on the know-how and work of the hygiene specialist in the future, because we can continue to expect infection prevention to remain challenging, especially with the rise of antibiotic resistant bacteria.

Sources

[1] Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Insitut “Händehygiene in Einrichtungen des Gesundheitswesens.” Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz 9 (2016): 1189.

[2] Heudorf, U., & Exner, M. (2011). Personelle und organisatorische Voraussetzungen zur Prävention nosokomialer Infektionen. Richtlinie und Realität 2009. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz, 54(3), 372-377.

[3] Stoliaroff-Pépin, A., Arvand, M., & Mielke, M. (2018). Hygienefachpersonal–wann ist der Bedarf gedeckt?. Epidemiologisches Bulletin (RKI), 45/2018, 479 – 492

[4] Bericht des GKV-Spitzenverbandes zum Hygienesonderprogramm in den Förderjahren 2013 bis 2019, Berlin, 31.07.2020

[5] Statistisches Bundesamt (2021). Grunddaten der Krankenhäuser – Fachserie 12 Reihe 6.1.1 – 2019.