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Hand hygiene: The most effective way to avoid nosocomial infections.
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Nosocomial infections are unnecessarily burdening the German healthcare system

The Robert Koch Institute has carried out a scientific study to investigate the frequency of hospital-acquired infections in Germany and their consequences.

Nosocomial infections are one of the most common complications that arise during treatment in medical institutions. Among other complications, when a patient acquires a nosocomial infection, it can significantly prolong the duration of their treatment, which is a concern felt by many patient during their hospital stay. In a 2019 study commissioned by the Kaufmännische Krankenkasse, the Forsa institute surveyed a representative sample of patients thoughout Germany. When asked what people are most afraid of when they are hospitalized, 81% responded, infection with a hospital germ. [1]

The likelihood of developing a nosocomial infection depends on a variety of factors. For example, immunocompromised patients are considered particularly at risk. Other factors can include a lack of nursing staff on the ward, as the resulting time pressure can increase the risk of transmission of germs to the patient.

More than 240,000 years of life lost to Hospital-acquired infections

As highlighted by a recent study by the Robert Koch Institute (RKI), in coordination with researchers from Berlin and Stockholm, hospital-acquired infections (HAIs) continue to burden the German healthcare system. In their analysis, the research team concentrated on five typical types of infection, including wound infections, urinary tract infections and pneumonia. Their findings indicate that more than 600,000 nosocomial infections occur throughout Germany every year. [2]

In addition to prolonged patient suffering, HAIs also create a considerable economic burden for clinics and hospitals. Researchers from the University Hospital in Jena analyzed in a paper that per case of infection, additional costs can exceed 11,000€. [3] The results currently published by the RKI are largely consistent with previous calculations regarding case numbers, which Professor Gastmeier from the Berlin Charité and her team published in 2008. Here, too, there is talk of over half a million HAIs. [4]

Patient deaths, resulting from complications associated with a HAI, are estimated at 20,000 cases per year, slightly higher than previous projections.

For the first time, the researchers also calculated the Disability-Adjusted Life-Years (DALYs) – a key figure that further reflects the burden of disease. Combined, the number of years of life lost to illness and death from nosocomial infections each year in Germany is just under 250,000 years.

This is a stark figure, illustrating how important it is to effectively combat pathogens before the infection develops, especially when considering the added complications from antibiotic-resistant germs. According to the European Centre for Disease Prevention and Control (ECDC), in Europe alone, the number of infections with antibiotic-resistant pathogens rose from just under 240,000 in 2007 to 600,000 in 2015 [5]. A large proportion of these infections occur primarily in healthcare facilities. As a consequence of this trend, the course of the disease is becoming increasingly severe.

Hand disinfection means infection prevention

Out of this research, the question arises, “how can we effectively counteract hospital-acquired infections?” The first and foremost defense against HAIs is careful hand hygiene. According to experts, up to 80 percent of all infectious pathogens are transmitted by the hands. Although hygienic hand disinfection is generally recognized as the most effective measure for infection prevention, it is still too rarely implemented, especially in clinics and hospitals. [6] Inadequately available or poorly accessible hand disinfectant dispensers and a lack of feedback to hospital staff on hygiene behaviour are among the issues negatively impacting hand hygiene compliance.

Making a sustained improvement in hand hygiene behaviour involves a variety of measures, taken together, including finding the right hand disinfection dispenser equipment, placed in the right location. Dispensers should be easily accessible, especially in the vicinity of the patient, or point-of-care. Bright, high-vis colours, and touch-free versions of disinfectant dispensers has also been shown to increase compliance rates. [7,8] Intelligent dispensers, which automatically record their usage data and even give immediate feedback to medical staff as soon as enough hand disinfectant has been removed from the dispenser, are another important component in a successful hygiene campaign.

In their conclusion, the researchers of the current RKI study also note that the main focus must continue to be on improving hand hygiene in order to keep nosocomial infections and the occurrence of multi-resistance under control in the long term.


[1] Kaufmännische Krankenkasse. Pressemitteilung vom 13.09.2019, Hannover. Hilfe, ich muss ins Krankenhaus! Online aufrufbar: https://www.kkh.de/presse/pressemeldungen/hilfe-ich-muss-ins-krankenhaus

[2] Zacher, Benedikt, et al. “Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012.” Eurosurveillance 24.46 (2019).

[3] Arefian, Habibollah, et al. “Extra length of stay and costs because of health care–associated infections at a German university hospital.” American journal of infection control 44.2 (2016): 160-166.

[4] Gastmeier, Petra, and Christine Geffers. “Nosokomiale Infektionen in Deutschland: Wie viele gibt es wirklich?.” DMW-Deutsche Medizinische Wochenschrift 133.21 (2008): 1111-1115.

[5] Cassini, Alessandro, et al. “Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis.” The Lancet infectious diseases 19.1 (2019): 56-66.

[6] Stahmeyer, J. T., et al. “Hand hygiene in intensive care units: a matter of time?.” Journal of Hospital Infection 95.4 (2017): 338-343.

[7] Scheithauer, Simone, et al. “Influence of signal colored hand disinfectant dispensers on hand hygiene compliance at a medical intensive care unit.” American journal of infection control 42.8 (2014): 926-928.

[8] Scheithauer, Simone, et. al. “Increase of alcoholic hand disinfection performance due to new touchless dispensers.” Abstracts of 21st ECCMID/27th


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