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Issues in 2015
The hospital hygiene police
Patients who suffer from hospital-acquired bacterial infections and are resistant to antibiotic therapies are a recurring theme in the media. Dr. Marco Rossi, Head of Infectious Diseases and Hospital Hygiene at the Luzerner Kantonsspital (Lucerne Cantonal Hospital), explains why in spite of their best efforts, hospitals will not succeed in completely eradicating hospital-acquired infections.
Dr. Marco Rossi, head of Infectious Diseases and Hospital Hygiene at the Luzerner Kantonsspital (Lucerne Cantonal Hospital)
Helsana: Are we right in assuming that more and more antibiotic-resistant bacteria are involved in hospital-acquired infections?
Marco Rossi: Antibiotic resistance is indeed a growing problem. However, it does not play a decisive role in hospital-acquired infections – so-called nosocomial infections. Most infections are caused by pathogens which the patient already has in their body when they come to hospital, and they usually have the pattern of resistance which is normal in our population.
Nevertheless: the topic of antibiotic resistance is a public concern. Are antibiotics used too generously in human medicine, veterinary medicine and animal breeding?
Seventy percent of all antibiotics are used in farming and veterinary medicine. That also indirectly facilitates resistance in humans. For instance, more and more people have resistant pathogens in their intestine. That is why the Federal Council initiated the antibiotic resistance strategy. In addition to the Federal Office of Public Health, the Federal Food Safety and Veterinary Office and the Federal Office for Agriculture are also involved in this strategy. It is important that everyone participates because the problem can only be solved using a coordinated approach. The farming lobby has so far successfully fought against the introduction of a monitoring programme to determine the level of use of antibiotics in farming. However, such a programme will also need to be implemented at some stage. Although it will no longer be possible to reduce antibiotic resistance, we could at least delay its increase.
What measures are you taking against resistant bacteria at the hospital?
We train people on the use of antibiotics: as short and targeted as possible and only as widely administered as necessary. Acute bronchitis, for example, should not be treated with antibiotics, because in 97 percent of cases it is caused by a viral infection. A urinary tract infection without any pain also requires no therapy. Every use of antibiotics destroys the body's healthy bacterial flora, and we should not disturb this flora unless absolutely necessary. For example, there is a type of intestinal infection which only occurs if certain types of antibiotics are used. So in this case, the antibiotic which is supposed to fight one infection actually causes another one.
How would you describe the duties of a Head of Infectious Diseases and Hospital Hygiene at a large hospital?
As an infectious disease specialist, I, together with my team, advise doctors on the treatment of patients with infections. In my capacity as a hospital hygienist, I deal with the hospital system: my team and I observe procedures, processes and practices and request that corrections be made where necessary.
So a type of hygiene police?
You are bound to make some enemies along the way.
I earn my salary for being recalcitrant, among other things. It is my responsibility to ensure that the team is used correctly, so that we can identify any problems at an early stage. In this sense, we are also a type of early warning system.
70,000 people contract an infection every year in Swiss hospitals, 2,000 of whom die as a result according to the Federal Office of Public Health. What are the most common infections?
Bladder infections in patients with urinary catheters, infected wounds after operations, infections caused by a blood vessel catheter, lung infections contracted during artificial respiration and intestinal infections resulting from antibiotic therapy. At the children's hospital, viral gastrointestinal and respiratory tract infections are most prevalent, because the children also play at the hospital and so are in close physical contact with each other.
Politicians and journalists ask why you do not have these infections under control.
The limits of what is possible in medicine have changed significantly. Nowadays, even elderly and seriously ill patients are operated on who wouldn't have been operated on in the past. There have been significant improvements in anaesthetic and operating techniques as well as intensive care. We treat leukaemia patients with aggressive therapies under which they live without a functioning immune system for weeks on end. When we break through the natural defence barriers, infections are unavoidable.
Is that the reason why infections are not decreasing in spite of the hospitals' best efforts?
Some infections decreased thanks to our measures, whereas others remained at the same level. Although we are constantly improving our system as well as standardising procedures and practices, patients remain very susceptible, because they are getting older and older and the clinical pictures are increasingly complex.
Is there anything patients can do to protect themselves against the risk of getting infected in hospital?
The risk decreases if the patient stops smoking a month before the operation. Overweight is also a risk factor which can – at least theoretically – be influenced. There is not much else they can do though.
How does smoking affect a patient's susceptibility to infection?
Smoking increases the risk of a wound infection after an operation. The worse blood circulation in the tissue weakens smokers' defences. If they stop smoking at the right time, this disadvantage can be eliminated.
So what does overweight have to do with hospital-acquired infections?
In case of obesity, the worse metabolic status has a negative impact on the body's defences. Metabolic status means the control of blood sugar and blood fat values. An obese person needs to exert much more effort to keep their blood sugar values within the normal range. If this control is lost, the sugar values increase, which due to the weakened defence cells leads to a greater risk of infection.
Can hospital visitors also help to reduce the risk of infection?
During the flu season, we ask visitors to disinfect their hands and to wear a mask if they have any symptoms of the common cold. Otherwise, visitors don't play any role in nosocomial infections.
Interview: Artur K. Vogel