Healthcare bodies need to work harder to convince the healthcare sector and the public that administering antibiotics too easily encourages the spread of resistant bacteria. Hospitals and other healthcare professionals operating in the same healthcare region also need to address this problem in an identical manner, since the weakest link in the healthcare chain determines the effectiveness of prevention, according to Alex Friedrich, professor of Medical Microbiology at the University of Groningen and University Medical Center Groningen (UMCG), in his inaugural lecture on Tuesday 18 June.
Now that the average age of the Dutch population is rising, more and more people are being admitted to hospital at some time during their life, for varying periods of time. As a result, the number of people who incur infection during their hospital stay is rising. ‘Figures show that between three and ten percent of hospital patients will become infected’, says Friedrich. ‘Half of these cases are impossible to prevent, for example because the patient’s immune system is compromised. The other half, however, deserves our close attention.’
Infections in hospitals are a result of contact and sometimes develop further because they often go undetected. Dutch hospitals do relatively well in this regard, since all hospitals have medical microbiologists with ‘an eye for the invisible’ who are indispensable in diagnosing infections. Friedrich: ‘German or French hospitals, for instance, have much more of a problem with this, and we know that hospital bacteria are thirty times more prevalent there as a result. Those with an eye for this invisible problem, the medical microbiologists, no longer have their own department in these hospitals.’ However, German hospitals are much better at preventing wound infections after an operation, which occur there much less often. ‘We don’t know exactly why this is the case, but in this respect the Netherlands has something to learn.’
Combating the risk of hospital infection involves three core aspects. ‘Without an eye for the invisible, you’re blind – that’s the first aspect’, says Friedrich, ‘so you need medical and molecular microbiologists.’ The second aspect is ensuring that bacteria are not given the run of the hospital. ‘Proper hand hygiene needs to be maintained by everyone who comes into contact with patients.’ And then there’s a third aspect, because the risk of infection still remains: ‘Only administer antibiotics when these are really necessary. It is precisely the administration of unnecessary antibiotics that gives resistant bacteria the opportunity to develop and spread in the patient’s body.’
According to Friedrich, a lot could be won in this latter regard within the healthcare regions of the Netherlands. He deliberately points out their role since policy will only be effective if this is identical across the healthcare region. ‘Having the right policy in just one hospital doesn’t work, since some of the patients will have been treated by their GP, or in a nursing home, or in a German or Belgian hospital, for instance. Hospital policy is already good, but research shows that for it to be successful, it’s the last bit of implementation that really counts. Everybody needs to participate, otherwise it won’t work.’ Support for the policy needs to be encouraged within the healthcare region and within the teams of healthcare professionals treating patients. The eye for the invisible, the clean hands at the bedside, and the decision-makers in the treatment teams will only succeed if there is cooperation.
Medical microbiologists have an important role to play in preventing the needless administration of antibiotics. Time is an issue in identifying microbes when infection is suspected. ‘It can easily take 36 hours before test results on whether or not antibiotics are needed are in. It seems that new methods could help to reduce this time to two hours, which would clearly be of benefit. When the invisible is made visible sooner, this would enable hospitals to decide more quickly whether antibiotics are necessary or if special hygienic measures would suffice. And every time antibiotics are not administered unnecessarily, the chances of becoming infected with resistant bacteria drops.’
Prof. Alex Friedrich is professor of Medical Microbiology at the University of Groningen and the UMCG, where he also heads the Medical Microbiology department. Last year, Friedrich received the Gesundheidtspreis Nordrhein-Westfalen for the UMCG project EurSafety Health-net, which focuses on infection prevention. Over one hundred Dutch and German hospitals and nursing homes now collaborate in the project; this is across four healthcare regions serving a population of over ten million.
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