Gram-negative bacteria pose a major challenge for hospitals


Every day, people are admitted to the hospital, discharged or they visit patients. This large number of people increases the risk of bacteria transmission. Preventative measures such as short-sleeved uniforms and copper surfaces can help by improving hospital hygiene but they cannot replace the legal requirements for hygiene measures.

Photo: physicians at station

In hospitals special hygiene regulations must be observed, for example the wearing of protective clothing; ©

The MRSA pathogen (Methicillin-resistant Staphylococcus aureus) can be transmitted through many different ways: between humans, from animals to humans and through contaminated equipment. Once the bacteria enter the body through wounds, it can lead to sepsis, pneumonia or urinary tract infections. The treacherous part about this: MRSA is resistant to approximately 20 percent of all antibiotics.

Hospitals, in particular, need to take preventative measures to protect patients with weakened immune systems. These measures are detailed in the recommendations by the Commission for Hospital Hygiene and Infection Prevention (KRINKO). "Germany has prepared a very comprehensive reference system which is already a central theme in medical degree curriculums", reports Prof. Martin Exner, President of the German Society of Hospital Hygiene and Director of the Institute for Hygiene and Public Health at the University of Bonn Medical Center. The top priority in hospital hygiene as well as in medical offices and healthcare settings is hand hygiene.

That being said, there is a multitude of pathogens that are not transmitted by hands. "There are different mandatory hygiene requirements for different types of interventions such as urinary tract infections or to prevent wound infections", says Exner. Further measures are currently being discussed; such as short-sleeved uniforms like the ones already used in the Roland Clinic in Bremen and the use of copper surfaces that kill microbes on contact. These measures can contribute to improving hospital hygiene but they are not a substitute for disinfecting equipment and hands. "It is up to each hospital to take various additional measures that are not regulated by law."

Photo: paper with the word MRSA, aside stethoscope

The antiobiotic resistance bacterium MRSA can be removed using a clean up of the human body; ©

Medical technology companies can help with devices

Ensuring water hygiene in hospitals is particularly important. Medical technology companies can also contribute to preventing leaks of tiny water-bound particles and pathogens like Legionella and Pseudomonas bacteria. Many hospitals use terminal tap water filter systems for instance. "The filter is attached to the faucet or used instead of the shower head and prevents the leak of dangerous pathogensby using a filtration system", explains Joachim Rösel, Director of Sales and Marketing at PALL Medical GmbH and Spokesperson of the BVMed sub-group "Nosocomial Infections".

Rösel believes the education of physicians and staff is very important. "Our products can only help in preventing nosocomial infections if they are being used correctly." That’s why communication between medical technology companies and hospitals is essential. The corresponding training courses to use the products on the part of medical device developers is specified in the Medical Devices Act. These courses are regularly offered at inpatient facilities, especially for hygiene experts. "It is also key for hospitals to collaborate with medical technology companies and to conduct studies on various technologies. This aspect needs to be further improved to be able to achieve the best possible insights into the use of medical devices in everyday hospital settings."

According to Exner, there is a significant potential for prevention primarily when it comes to shower drains, sinks, and toilets. Gram-negative bacteria such as E. coli and Klebsiella pneumoniae are resistant to multiple antibiotics and detectable in sewage systems. These bacteria are especially dangerous for patients with weakened immune systems. "In the future, we face an increase in gram-negative bacteria since we don’t have the option of remedial actions, as is the case with MRSA for example", says Exner. A remedial action, consisting of combining an antibiotic nasal ointment with a disinfectant shampoo, can be successful in fighting MRSA. The number of MRSA infections in hospitals has considerably decreased over the past few years.

High-risk patients are especially those people who have recently visited foreign countries, patients with chronic conditions and complex care needs, patient on dialysis and patients with wounds and burn injuries. A screening, during which a swab of the nose, throat or wound is taken, is designed to detect the antibiotic-resistant bacteria. In addition, infected patients need to be treated in isolation to prevent a spread.

Other countries take more intensive measures

The number of MRSA patients in the Netherlands is far less than in Germany.The country has already taken measures to fight this bacteria during the 80s. Germany detected MRSA as the cause of nosocomial infections not until much later. What’s more, the bacteria has not developed resistances as much in the Netherlands as it did in Germany, since antibiotics are used less frequently there to treat infections.

Physicians in Israel also faced major challenges in 2006. The gut bacteria Klebsiella pneumoniae caused a downright epidemic. Infected patients were placed in isolation and treated by special nursing staff. Thanks to a collaboration between policy makers and hospitals, the country already had an active screening process in place for high-risk patients. Due to financial reasons and time constraints as well as a shortage of staff, this type of screening is not feasible in Germany.

"The challenge we are facing globally is to prevent the spread of antibiotic-resistant bacteria. This is why we need to increase our attention to returning travelers", Exner points out. In certain regions such as South India and Southeast Asia, many travelers frequently carry the bacteria unnoticed on their skin. This needs to be a special consideration when patients are being admitted.

Exner also sees the need for further action in fighting antibiotic-resistant bacteria. "We need more single patient or double occupancy rooms with integrated toilets and showers." These structural measures are designed to offer patients more room and thus prevent the spread of bacteria. Patients should also be trained in personal hygiene measures.

Photo: Lorraine Dindas

© B. Frommann

The article was written by Lorraine Dindas and translated from German by Elena O'Meara.