The new German hygiene law regulations and. VHIG congress, 18 April, 2012 Almelo, Netherlands. Walter Popp

Transcription

1 The new German hygiene law regulations and implementation VHIG congress, 18 April, 2012 Almelo, Netherlands Walter Popp

2 Folie Autor

3 1989 Folie Autor

4 Germany 16 federal states. States have many duties in healthcare, e.g. legislation. Folie Autor

5 Conference of state health ministers 1991 demands: Hospital hygienists (doctors) Hygiene nurses Link nurses and doctors Hygiene commission Documentation of nosocomial infections Folie Autor

6 State hygiene regulations Berlin (1985) Bremen (1990) Nordrhein-Westfalen (1989) Sachsen (1998)

7 No state hygiene regulations Bayern (2010) Hessen (2012) Baden-Württemberg (2010) Rheinland-Pfalz Saarland (2007) Brandenburg Thüringen Sachsen - Anhalt Schleswig-Holstein Hamburg Niedersachsen Mecklenburg-Vorpommern

8 1992 Folie Autor

9 1994 Folie Autor

10 1996 First study: German Hospital Federation 6 % NI NIDEP: 3,5 % Politicians: how nice, no problem Folie Autor

11 Folie Autor

12 Folie Autor

13 Nosocomial infections per year in Germany KISS SepNet, DGP Sepsis Pneumonia Urinary tract infections SIS Others Sum Folie Autor

14 MRSA prevalence in hospitals KISS (2010): 0.75 % MRE networks: Saarland: 2.2 % Siegen-Wittgenstein: 1.4 % Sachsen-Anhalt: 1.1 % Kreis Höxter: 3.4 % Netzwerk Euregio MRSA-net, Münster: 1.6 % Gelsenkirchen: 2.5 % Essen: 2 % Folie Autor

15 Outbreak in Giessen 1997 Neonatology of University Clinics Giessen neonates infected by Klebsiella oxytoca 4 died 24 have physical and mental illness Bacteria was found in surface disinfectant Court: Handicapped baby Compensation 250,000 Annuity lifelong 800 per month Folie Autor

16 DGKH hygiene doctors needed Only 5 % of hospitals have hygiene doctors Folie Autor

17 2009 Left party (post communists) Draft law about hospital hygiene Hearing in Health Select Committee of German Parliament Law did not pass Parliament But start of interest of political parties Folie Autor

18 DGKH: Survey by Infratest in 2010 Each hospital should have a hygiene doctor and hygiene nurses: 68 % The big number of nosocomial infections is a scandal: 56 % Hygiene in hospitals must urgently be improved: 49 % Politics has to care for the issue: 48 % I would accept higher costs if hospital hygiene would be improved: 35 % Folie Autor

19 End of 2010 MPs Ackermann und Lindner, FDP (Liberals) own draft law Followed by coalition parties (CDU, FDP Conservatives, Liberals) draft law Also oppositional parties: SPD, Grüne (Social Democratics, Green party) Folie Autor

20 Infection protection changing act Passing Parliament in June 2011 Passing also States Chamber without problems Folie Autor

21 Infection protection act 23 Nosocomial infections Commission for hospital hygiene and infection prevention (KRINKO) at Robert Koch Institute (RKI) Develops recommendations to prevent nosocomial infections Ongoing update mandatory Folie Autor

22 Infection protection act 23 Nosocomial infections Commission for antiinfectiva, resistence and therapy (ART) at Robert Koch Institute New! Develops recommendations for diagnostics and therapy, based on epidemiologic evaluations Ongoing update mandatory Folie Autor

23 Infection protection act 23 Nosocomial infections Heads of hospitals are in charge of hospital hygiene working according to scientific knowledge Recommendations of KRINKO and ART have to be implemented New! Example: Recommendation re staff structure from 2009 If not > lack of organisation > legal consequences Statistics about nosocomial infections and multiresistant bacteria Also conclusions, consequences and training of staff about new regulations Hygiene plan in each hospital (old) Folie Autor

24 Infection protection act 23 Nosocomial infections Hospital hygiene regulations in each state until end of March 2012 Folie Autor

25 Problem: MRSA decontamination stops when patient is leaving hospital Reason: no money for practitioners Folie Autor

26 Folie Autor Number Points Round-about in (estimated point price ) 86770: Clarifying MRSA status of a risk patient until 6 months after leaving hospital 100, once in a case : Therapy and management of a risk patient with MRSA or of a contact person with MRSA 375, once in a case or decontamination cycle : Education and advicing a risk patient with MRSA or of a proven contact person 255, for each 10 minutes, maximum twice in a decontamination cylce : Diagonistic of a contact person after failed decontamination of a person with MRSA 90, once in a case : participation in a MRSA case or network conference 130, once in a case : confirmation of MRSA by swab 55, maximum twice in a case : Exclusion of MRSA by swab 55, maximum twice in a case : MRSA confirmation by chromogenic agar : identification of Koagulase and/or Clumpingfactor 2.55

27 Doctors Must have a specialisation in infectiology or 3-hours-course or online course, Must be members in a MRSA network. Patients Risk groups: Inpatient in last 6 months AND risk factors (that means not all KRINKO risk groups) Also contact persons Prescription of antiseptic solutions (throat, skin) not clear. Folie Autor Number Points Round-about in (estimated point price ) 86770: Clarifying MRSA status of a risk patient until 6 months after leaving hospital 100, once in a case : Therapy and management of a risk patient with MRSA or of a contact person with MRSA 375, once in a case or decontamination cycle : Education and advicing a risk patient with MRSA or of a proven contact person 255, for each 10 minutes, maximum twice in a decontamination cylce : Diagonistic of a contact person after failed decontamination of a person with MRSA 90, once in a case : participation in a MRSA case or network conference 130, once in a case : confirmation of MRSA by swab 55, maximum twice in a case : Exclusion of MRSA by swab 55, maximum twice in a case : MRSA confirmation by chromogenic agar : identification of Koagulase and/or Clumpingfactor 2.55

28 Social Act V (SGB V) 137 (old) Hospitals are under duty to participate in measures of quality assurance Sozialgesetzbuch V (SGB V) 137 Die Krankenhäuser sind verpflichtet, sich an Maßnahmen der Qualitätssicherung zu beteiligen. Folie Autor

29 Federal Joint Committee (G-BA) Established in Main decision making body in German health care. Issues legally binding directives. Represents organisations of physicians, hospitals, sickness funds and patients. Evidence-based coverage decisions regarding innovations for outpatient and hospital care (which therapy, drugs sickness funds have to pay for) Quality directives according to Federal Joint Committee (G-BA) Quality reports of all hospitals every 2 years (mainly structure, most important DRGs). External quality report every year, e.g. structure data, some mortality and infection data on federal mean level. Minimum rates for treatment, e.g. Liver transplantation: 20 Bone marrow transplantation: 25 Neonatology regulations. Folie Autor

30 Federal Joint Committee G-BA Develop benchmarking parameters for hospital hygiene Parameters must overlap sectors Folie Autor

31 Aqua Institute task from G-BA: SIS Indicator operations must be done inpatient and outpatient -> no heart operation, no HPRO Central venous catheter associated infections Central venous catheters are not used by practitioners Ports? Folie Autor

32 Staff according to KRINKO 2009 Hygiene doctors: fulltime over 400 beds hygiene doctors in Germany 30 (?) with authorization of Medical Councils to qualify new hygiene doctors (5 years) Hygiene nurses: around 100 % more needed Can be reached in 4-5 years Link doctors and nurses Can be reached in 2-3 years Folie Autor

33 Discussion about structured training of hospital hygienists (interim solution) Requirement: Specialisation in clinical medicine (internal medicine, surgery ). Start: Modul I of curriculum ( link doctor ). Search for a mentor and make treaty with him/her. Course: Additional 5 courses (200 h). From the beginning fulltime hospital hygienist in his/her hospital ( Trainee ) Help from mentor. Meeting with mentor at least once a month. Duration: 2 years. Graduation: Examination at Medical Council. Mentor requirements: Authorization of at least 2 years to qualify doctors for hospital hygiene or microbiology, additionally experiences in hospital hygiene. Folie Autor

34 Big step after 20 years of stagnation. Conclusion More staff: Hygiene nurses doubled. Fulltime hygiene doctors in big hospitals. Link doctors and nurses. Importance of hospital hygiene will grow. Pressure from justice will grow. Heads of hospitals are in charge. More hygiene in education needed, especially in medical students. More hygiene institutes needed at universities. Development of valide benchmarking parameters. Folie Autor