1. Developments in Hospital Hygiene in Germany Christoph Huesmann Specialist Nurse for hygiene and infection prevention

5. Development of resistance 3 rd generation Cephalosporin resistant isolates Key Grey = Resident Doctors (N) Red = Dialysis centres (D) Yellow = Hospitals (K)

6. DART Deutsche Antibiotika- Resistenzstrategie* *German Antibiotic Resistance Strategy

12. KISS Hospital Infection Surveillance System OP-KISS Model Time period: January 2006 – December 2010 Reference data – Rates of wound infection Type of operation: knee arthroscopy Table 1: Wound infection rate by risk category Table 2: Wound infection rate by infection type Translation Wound infection rate Risk Category Number of departments Number of operations Number of wound infections Mean 25% quartile Median 75% Quartile 0 29 7958 9 0.11 0.00 0.00 0.00 1, 2, 3 29 4303 31 0.72 0.00 0.00 1.16 0, 1, 2, 3 29 12261 40 0.33 0.00 0.00 0.60 Wound infection rate Type of infection Number of departments Number of operations Number of wound infections Mean 25% quartile Median 75% quartile A1 29 12261 11 0.09 0.00 0.00 0.00 A2, A3 29 12261 29 0.24 0.00 0.00 0.40

15. Animal feed “ We can therefore assume that most battery hens receive antibiotics for around two-thirds of their lives –although they only live for 32 days“ – Hermann Focke, author of ‘Tierschutz in Deutschland – Etikettenschwindel?!‘* *The protection of animals in Germany – false labelling?!

17. 50% – 60% laMRSA* ? *livestock-acquired MRSA

18. Publicity *Verotoxin-producing Escherichia coli EHEC in Germany – Is this only the beginning? LATEST Scientific forum Petersberg with Nina Ruge – Broadcasted on 31/10/2010 at 1pm and 10.30pm on „Phönix“ (information channel from ARD and ZDF): Illness due to clinical germs – The underestimated danger Nina Ruge spoke with: Dr. Alexander Friedrich, Institut für Hygiene, Universitätsklinikum Münster (Institute for Hygiene, University clinic Münster) Dr. Burkhard Kirchhoff, patient lawyer Dr. Rudolf Kösterst, President of the Deutsche Krankenhausgesellschaft (the German Association of Hospitals) Prof. Dr. Martin Mielke, leader in the field of applied infection and hospital hygiene, Robert-Koch-Institut Berlin The revenge of bacteria New information on resistant microbes The programme ARTE reported on the newest strategies and scientific knowledge in the fight against bacteria on 15/10/2010 at 21.45. Antibiotic research in the hands of the state? Is Germany and the world armed against superbugs? Critical comments on the situation in Germany Anne Will – Programme broadcasted on 29/8/2010 on ZDF: "Killer germs in hospitals – How dangerous are our clinics?" The ZDF programme "ML Mona-Lisa" broadcasted a report „Ill due to the hospital" on 29/08/2010 about the fate of one of our clients 3 dead infants in Mainz – Bacteria claims more victims in Germany! Is the "Superbacterium“ NDM-1 really new? This development was foreseeable Our summary of NDM-1!

36. Staff and organisational requirements for the prevention of nosocomial infections Recommendations from the Commission for Hospital Hygiene and infection prevention

43. Tab 3. Qualifications and tasks for hygiene representatives in care Requirements Qualified nurse, with several years’ experience Tasks Operational/organisational -Communication partner as well as the connection to members of the hygiene teams -Regularly taking part in hygiene training/ further education - “Propagator” of hygiene-relevant topics in wards or area of work -Taking part in workgroups/quality groups Departmental/area support by specialist staff - Collaborating to deal with area-specific infection risks -Collaborating to establish area-specific hygiene plans and standards -Small group lessons about correct hygiene practices for critical care measures -Task-related transfer of correct hygiene practices in own area of responsibility Outbreak management - Early warning of clusters/outbreaks and information about transmission to the hygiene specialists -Collaborating to organise coping with epidemic recurrent hospital infections

47. Strategies

48. 8. Osnabrücker Hygienetag 2010 The task of the hygiene specialist (of the hygiene manager) is to investigate into the dangers of infection and from that produce/ release, implement and examine procedural rules which have direct or indirect effects on infection. Implementing “hygiene-musts” Job-orientated tasks Personal hygiene Cleaning and disinfection Room requirements/ projects Purchasing requirements Care and waste disposal Establishing procedural rules Implementing procedural rules Creating requirements Training staff Advisory services Practical instructions Lectures/ lessons Releasing procedural instructions made by third parties Inspections of areas Observing work Employee questionnaires Structural/ functional Area investigations Statistics e.g. infection statistics e.g. resistance statistics e.g. Hand-KISS Adjustments to the status of science and technology Measures that act as checks

50. Number of hand disinfections per day of care – average per quarter Ward No.