Which hygiene measures best protect against hospital germs?
NUM project PREVENT investigates how bloodstream infections caused by vancomycin-resistant enterococci (VRE) can be prevented
Although enterococci are natural inhabitants of the gut, vancomycin-resistant enterococci (VRE) areconsidered typical multi-resistant hospital germs. They occur primarily in hospitals and care facilities, where they are favoured by factors such as immunocompromised patients, the frequent use of antibiotics and invasive procedures. The new PREVENT study in the Network of University Medicine (NUM) is investigating how frequently bloodstream infections caused by VRE occur and which factors - such as the patient's state of health, the treatment or the hygiene measures used in the hospital - play a role in this. The aim is to find out which measures are really effective in better preventing infections. The study, in which 22 academic medical centres are participating, was initiated by Prof. Dr Stefanie Kampmeier, Head of the Central Facility for Hospital Hygiene and Antimicrobial Stewardship at the University Hospital of Würzburg (UKW).
Würzburg. Enterococci are part of the natural intestinal flora and are harmless for most people. However, the resistant bacteria can become problematic if they enter the blood, urinary tract or wounds and cause infections there. This is particularly the case if the body's own defences are weakened. The situation becomes more complicated when enterococci are resistant to antibiotics, such as vancomycin. Vancomycin-resistant enterococci (VRE) pose a major risk in hospitals. This is because many risk factors come together here: immunosuppressive therapies, frequent administration of antibiotics that promote resistance and medical interventions that create additional entry points for the pathogens. If VRE enter the bloodstream, they can trigger a bloodstream infection that can lead to septicaemia. This is an exuberant inflammatory reaction which, in the worst case, leads to multi-organ failure.
PREVENT study is funded as part of the NUM Specialised Network on Infections (SNID)
Preventing these life-threatening VRE bloodstream infections is therefore the be-all and end-all. "PREVENT - Prevention of bloodstream infections with vancomycin resistant enterococci" - is therefore the name of the new project in the Network of University Medicine (NUM). The multi-centre study was initiated by Prof. Dr Stefanie Kampmeier, Head of the central Hospital Hygiene and Antimicrobial Stewardship unit at the University Hospital of Würzburg (UKW). The Professor of Hospital Hygiene specialises in microbiology, virology and infection epidemiology as well as hygiene and environmental medicine. She was recently elected section spokesperson of the Bavarian Surveillance Centre (BaySurv), which deals with the continuous surveillance of relevant pathogens using modern molecular and data-based methods as part of the Bavarian Centre for Preventive Infection Medicine (BZI). Last but not least, Stefanie Kampmeier is co-spokesperson of the NUM Specialist Network Infections (SNID).
"Who wants to say thank you for not being infected with a multi-resistant pathogen in hospital?"
Stefanie Kampmeier is particularly pleased that her PREVENT project is now one of the six studies funded by the Federal Ministry of Research, Technology and Space (BMFTR) in the SNID. This is a great success. Hygiene often leads a shadowy existence, as many people take it for granted. "Who says thank you for not being infected with a multi-resistant pathogen in hospital?" asks Stefanie Kampmeier. But it is not a matter of course. In addition, many factors regarding the cause, development, spread and prevention have not yet been clarified.
More evidence for the development of national recommendations for the hygienic handling of VRE
The project manager lists the objectives of PREVENT: "Firstly, we are looking at how often patients in German academic medical centres get bloodstream infections caused by VRE. We then investigate which factors - from the patients to the pathogen strains to the hospital organisation - influence the risk. We are particularly interested in the influence of hygiene measures and the controlled use of antibiotics on VRE bloodstream infections. We are also analysing which prognostic factors determine the course of the disease in those affected."
Ultimately, the study team hopes to obtain more evidence for the development of national recommendations for the hygienic handling of VRE in hospitals and healthcare facilities.
Different hygiene measures, perceptions and implementations
According to Kampmeier, the Robert Koch-Institute's recommendations for action, which are issued by the Commission for Infection Prevention in Medical Facilities and in Care and Integration Organisations (KRINKO), are currently still very generically formulated. Accordingly, hygiene measures are implemented differently in clinics and hospitals as well as on individual wards.
"When we talk about hygiene, we tend to mean bundled measures to prevent infection," says Stefanie Kampmeier. This includes, for example, isolating patients if multi-resistant or highly infectious pathogens are detected. There are also surface disinfection measures, the involvement of patients, for example in hand disinfection, and the wearing of protective clothing such as gowns and gloves. Everyone acts differently. And even if everyone talks about protective clothing, it is not necessarily clear whether the same thing is meant.
The UKW is currently focussing on less isolation and more hand disinfection and monitoring - with success
When Stefanie Kampmeier joined the UKW in July 2023, patients undergoing stem cell transplants and seriously ill people with VRE were isolated. In consultation with the individual clinics, Kampmeier ensured that no one was isolated any more, but that basic hygiene measures and monitoring were intensified. "We have actually seen a drop in bloodstream infections," says Kampmeier happily. Her reasoning: "If I have to isolate patients with multi-resistant germs and have to put on full protective equipment every time I come into contact with them, I lose a lot of time that could be better spent on and with the patient. The more often I see the patient, the faster I can react to any deterioration." The psychological benefits for patients should not be underestimated either. "At the moment, our success is proving us right," says Kampmeier. "But in terms of nationwide inpatient care, there is still a lack of scientific evidence as to which measures really help to prevent VRE infections."
Whole genome sequencing of the pathogens
The pathogens themselves are also to be analysed. Whole genome sequencing will be used to create genetic fingerprints of the pathogens and identify risk profiles in order to derive targeted prevention measures from these. "There are so many exciting aspects that contribute to interdisciplinary infection prevention and should include people and pathogens holistically. This is exactly what makes my and our joint work so appealing," says Stefanie Kampmeier.
Text: Kirstin Linkamp / Science Communication University Medicine Würzburg