In Europe, one in ten patients picks up an infection while in hospital. At least three million people contract what are known as nosocomial infections each year, and more than 50,000 actually die as a result. In Germany alone, between 500,000 and a million people contract infections while in hospital, and the risk of infection on intensive care units is over 15 percent.

Most worrying of all is the fact that many of the bacteria that cause these infections are no longer susceptible to conventional antibiotics, since "superbacteria" such as multiresistant staphylococcus aureus (MRSA) have been allowed to evolve. They are highly contagious, difficult to fight, and the most common cause of life-threatening infections in hospital patients.

"The medical profession has yet to find a satisfactory solution to this acute problem," says Michael Wiechmann, Head of the Benefit and Healthcare Management department at Allianz Private Krankenversicherungs-AG. "These infections need to be taken seriously if for no other reason than the fact that they are responsible for a large number of complications in hospitalized patients."

With its report "Infectious hospitals. Resistant pathogens – a lurking threat to patients and healthcare systems," Allianz hopes to help raise awareness of the problem. The key facts were assembled and presented in language comprehensible to the layperson, as a resource for those interested in the issue.

Leading scientists such as Axel Kramer, President of the German Society for Hospital Hygiene (Deutsche Gesellschaft für Krankenhaushygiene - DGKH), Markus Dettenkofer of the University of Freiburg, and J. Glenn Morris of the University of Maryland explain why resistant pathogens can be dangerous and what steps people can take to protect themselves. "Our intention is neither to stir up panic, nor to play down the dangers," says Michael Wiechmann.

Drug-resistant pathogens often develop as a result of repeated indiscriminate or unwarranted use of antibiotics. "Many of the antibiotics prescribed nowadays are unnecessary," says Axel Kramer, President of the German Society for Hospital Hygiene and Director of the Institute for Hygiene and Environmental Medicine at the University of Greifswald. "Resistance is promoted by incorrect use of antibiotics, taking them in insufficient doses, and taking them for too short or too long a period."

The German Society for Hospital Hygiene (DGKH) is calling for a nationwide prevention strategy in Germany, since the German states now have the legislative authority to implement hospital hygiene standards. "Only four German states have passed a Hospital Hygiene Act," points out Axel Kramer. It is high time that politicians finally put the problem of hospital hygiene in Germany at the top of their agenda, he continues.

"In emergency hospitals with more than 450 beds, we need full-time hospital hygienists, and for every 300 beds there should be a nurse specially trained in hospital hygiene," says Kramer. He also believes the state should provide additional resources for training medical students as well as further training resources for doctors specializing in hygiene.

"These provisions must also be made law via the hygiene acts passed by the individual German states," continues the President of the DGKH. "Finally, to implement these provisions on wide scale, health insurance companies should only be permitted to make contracts with hospitals that have established a functioning quality management system for hospital hygiene."

The dramatic increase in the number of resistant and multiresistant pathogens and the corresponding rise in infection rates puts a burden on the entire German healthcare system and also increases non-wage labor costs, already the subject of hot debate. Although the direct and indirect costs of this problem are extremely difficult to quantify, the cost to both state and private health insurers alike is clearly enormous.

Hospitals will also find it increasingly difficult to obtain insurance cover unless they have a functioning risk management system, since only a few insurance companies still are willing to give policies to hospitals. Premiums for liability insurance, for example, have soared in recent years, and there are already some hospitals that have no insurance cover.

Providing knowledge about nosocomial infections is a big challenge. For some time now, hospitals such as the Greifswald University Hospital and the Vivantes Clinics in Berlin have been using new methods to achieve this goal. They are pioneers in Germany of what is known as the multibarrier concept.

"We give every member of our staff comprehensive hygiene training and always ensure that hygiene guidelines are strictly observed," says Claus Bartels, Medical Director of Greifswald University Hospital. "At the same time, we use antibiotics in a restricted and selective way."

At a time when limitations on hospital budgets make cost reduction critically necessary, prevention of nosocomial infections and rational use of antibiotics can reduce the financial burden considerably. Although consistent prevention of infections requires resources, these are quickly recovered by the reduction in the length of hospital stays, so in the long term, it is definitely worthwhile.

"We believe that in the long term, hospitals that disregard the need to combat resistant and multiresistant pathogens will have to deal with negative financial effects," says Michael Wiechmann of Allianz.

Hospitals could profit from the experience of the insurance industry when introducing risk management systems that ensure adequate monitoring and reporting of infections. Insurance companies have a pool of historic risk data and extensive experience in process management. "In the future, the only hospitals able to survive on the market will be those that consistently meet the requirements of patients, referring physicians, health insurance companies, banks, insurance companies, and legislators," predicts Wiechmann.

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