Although comprehensive data on the prevalence of nosocomial infection and the transmission of multiresistant pathogens in hospitals are available in Germany, data are scarce on infections associated with outpatient medical treatment. This has two major reasons: on the one hand, the risk of infection in the outpatient setting is estimated to be much lower, because the patients—except for those having outpatient dialysis, endoscopies, or outpatient surgery—experience very few invasive diagnostic and therapeutic measures. On the other hand, it is methodologically complex to follow up the cohorts of patients after outpatient treatment in a systematic fashion, in order to identify such infections.
This is also the reason why there are hardly any intervention studies of medically sensible preventive measures in the outpatient setting; for this reason, preventive recommendations from the inpatient setting are usually transferred to the outpatient setting, which in our opinion is not necessarily a perfect match for the specific problems that may occur. However, certain preventive measures undoubtedly have great importance in the outpatient setting too. Hand disinfection is without doubt one of these. Many doctors working in the outpatient setting have not yet accepted the indications recommended by the World Health Organization (WHO) for hand disinfection for themselves and therefore do not regularly implement them. This is confirmed by data from the “AKTION Saubere Hände [national hand hygiene campaign in Germany]”: 622 German hospitals provided data on their consumption of hand disinfectants, whereas only 40 doctors’ practices participated in the campaign. The average use of alcohol based hand disinfectant per treated patient in the practices was only 3.8 mL per case, barely more than is required for disinfecting hands once for every patient. The participating practices showed wide variation in this respect.
Dr. rer. medic. Michael Behnke
Institut für Hygiene und Umweltmedizin
Conflict of interest statement
The authors of both contributions declare that no conflict of interest exists.
|1.||Behnke M, Hansen S, Leistner R, et al.: Nosocomial infection and antibiotic use: A Second National Prevalence Study in Germany. Dtsch Arztebl Int 2013; 110(38): 627–33 VOLLTEXT|