The number of infections contracted by patients undergoing treatment in German hospitals has not decreased despite stricter hygiene requirements during the Corona pandemic. On the contrary, it has even risen further. This is the result of the new Barmer Hospital Report, which was presented in Berlin. According to the report, by the end of 2020, there were about 34,000 additional infected people and up to 1,300 more deaths due to so-called nosocomial infections, many of them caused by multi-resistant germs, throughout Germany.

The head of the health insurance company, Christoph Straub, has two explanations for the development, which at first glance seems surprising. On the one hand, especially during the first wave, there were fewer mild cases and significantly more older and more seriously ill people on the wards, who are more susceptible to infections, he said. In addition, there was a high workload for hospital staff, who sometimes lacked protective equipment at the beginning of the pandemic.

"Hospital staff were apparently so burdened during the Corona pandemic that they were not always able to fully comply with the high hygiene standards required," affirmed Boris Augurzky, co-author of the report and head of the "Health" competence area at the RWI Leibniz Institute for Economic Research in Essen. This is "an extremely important aspect, especially in times of pandemic, which can make the difference between life and death.

According to the study, nosocomial infections occurred in an average of about 5.6 percent of hospital cases from 2017 to 2019. This is based on a sample of five million cases. Then, immediately at the start of the pandemic, that figure rose to 6.8 percent, an increase of more than one-fifth within a few weeks. The rate then remained above six percent throughout the rest of the year.

In the study, the four-member team of authors was careful "not to compare apples with oranges," Augurzky emphasized. In fact, the number of hospital patients fell by up to 46 percent during the first phase of the pandemic. At that time, it was mainly more severe cases with a higher risk of infection that were treated. However, even if the changed patient structure is taken into account separately through adjustment, there was an increase in the number of infections by almost ten percent in the first wave and by 17.5 percent in the second wave by the end of 2020. According to the hospital expert, it is not only from the patients' point of view that everything must be done to prevent these infections. The treatment of infected patients is also extremely expensive for the insured community, with additional costs of around 1.5 billion euros annually, he said.

"The increased likelihood of acquiring a nosocomial infection seems to be an indirect and undesirable side effect of the pandemic," Augurzky summed up. However, even without Corona, about 400,000 to 600,000 patients in Germany contract hospital-acquired infections each year, and 10,000 to 15,000 of these are fatal. The researchers believe that around 30 percent of these infections could be avoided through appropriate prevention.

Because of the continuing explosive nature of the issue, hospital hygiene must become "a national health goal," demanded Straub, the head of the health insurance fund. After all, many billions are also invested in reducing the number of road accidents, he argued. "We need a master plan and concerted action." And first and foremost, he said, this would require better data and an evaluation of the measures taken so far.

In concrete terms, Straub said, there is a need for more discussion of hospital hygiene in the training of doctors and nurses. Such knowledge must then be "deepened in everyday work and become a daily routine. This requires reliable procedures and trained staff who can monitor compliance with hygiene standards and develop them further if necessary. Hospitals already employ hygiene specialists, he said. "However, the acceptance and work of these specialists must be strengthened in everyday work so that in exceptional situations such as a pandemic, higher hygiene requirements do not lead to stressful situations."

In addition, more transparency must be created about nosocomial infections in hospitals. The corresponding laboratory findings have not yet been included in the accounting data of the health insurance companies, Straub criticized. As a result, hospital-acquired infections can currently only be determined approximately. In the future, these infections will have to be "clearly mapped" in the classification system for medical diagnoses, the so-called ICD catalog. In addition, their coding must become obligatory in billing with the health insurance funds. In the view of the head of the health insurer, it should "distinguish both the type of pathogen and the fact whether the infection occurred before or during a hospital stay". This would allow valuable conclusions to be drawn as to where hygiene measures need to be improved.

However, Straub urged that compliance with hygiene standards should not only be checked internally, but also by the public health service to a greater extent than in the past, and also unannounced. If deficiencies remain a matter of interpretation and can only be criticized, but not made public, then controls are also "toothless tigers". For this reason, the Federal Joint Committee (G-BA) and the Robert Koch Institute (RKI) should develop a guideline with binding minimum requirements. The hospitals would then have to publish compliance with these requirements in their quality reports.

Image by Klaus Hausmann