COVID-19 in full inpatient care facillities - a never ending story?

Since March 2020, the corona pandemic has consistently exposed the weaknesses of the inpatient care system at the expense of those in need of case. No population group in Germany died more frequently as a result of corona-related infections (outbreaks) than residents of inpatient care facilities. By the end of March 2022. nearly 60% of Munich nursing home residents had become nosocomially infected with COVID-19, of which 18% died COVID-19 associated. Inadequate hygiene measures in the facilities could not and still cannot prevent large outbreaks. Because nursing facilities were not previously required to have hygienic staff, the Munich Health Department conducted standardized inspections and consultations during outbreaks. In almost no facility was a professionally correct outbreak management implemented. In addition, numerous hygiene deficiencies were identified that favored the transmission of SARS-CoV-2 infections to third parties. Furthermore, it became apparent that despite years of professional advice to the nursing facilities, no lasting positive effect on their hygiene management could be achieved. There are several reasons for this: a very high staff turnover, a low ratio of skilled workers, and a lack of commitment on the part of the facilities to a structured hygiene management system. Due to the continuing risk to the vulnerable population group in full inpatient care facilities, there is a fundamental need for regulation of binding hygiene management in these facilities - also with regard to risks from outbreaks with other pathogens. This was met by the legislature in September 2022 with an amendment to the Infection Protection Act. However, the theory-practice transfer required for functioning hygiene management can only succeed if sufficient numbers of professionally qualified staff with knowledge of German are available in the facilities to care for those in need of care.

Nosocomial COVID-19 outbreaks in inpatient care facilities: causes and requirements

This article identified the source and reason for spread of COVID-19 infection and devise recommendations to halt the progress of infection in a non-COVID area. Results showed that 34 persons were impacted by the outbreak, which lasted from December 19, 2020, to January 12, 2021. Attack frequency was 9.2%. This study determined that inadequacies in infection control procedures, a high bed-to-patient ratio, anomalies in the ventilation system, overcrowding by patient attendants, and a communication gap between nursing officers and doctors were the root causes of the present outbreak. After the last confirmed case, the necessary controls for the outbreak were put in place, and no new instances were recorded for two weeks. SARS-CoV 2 nosocomial outbreaks are a concern in non-COVID hospital settings as well, so it is important to adhere to the same tight infection control procedures there as in COVID areas to stop these outbreaks.

[COVID-19-associated deaths]. / COVID-19-assoziierte Sterbefälle: Erste Daten aus Münchner Todesbescheinigungen.

INTRODUCTION: In December 2019, the new infectious coronavirus disease 2019 (COVID-19) first appeared in China. So far, no systematic evaluation of death certificates of COVID-19-associated deaths has been presented. METHODS: The death certificates of all deaths in Munich during the period from 1 March to 31 July 2020 were analyzed. The previously defined inclusion criteria were the indication of corona, COVID-19 and SARS-CoV­2 in the death certificates. The variables were entered anonymously according to a developed key. The collected data were evaluated descriptively. RESULTS: In the period under investigation, a total of 5840 people died in the Munich City area. Of these deaths 332 (5.7%) were COVID-19-associated. In 281 deaths (84.6%) there was a definite COVID-19 and in 51 deaths (15.4%) the suspicion of this disease. The most frequent causes of death were acute respiratory distress syndrome or respiratory insufficiency (59.1%), multiple organ failure (21.4%) and sepsis (10%). An average of 1.8 pre-existing illnesses were reported in the death certificates. Most frequently mentioned were diseases of the circulatory system (54.8%), the nervous system (22.8%) and metabolic diseases (18.9%). The average age at death was 79 years and the most frequent place of death was a hospital (85%). An autopsy was attempted by the doctors who issued the death certificates for 18.1% of the collective, most frequently in the case of unexplained or unnatural causes of death and young age of the deceased. Clinical pathological autopsies were performed on 11% of the collective and judicial autopsies on 1%. DISCUSSION: This study is the first evaluation of death certificates with respect to the novel infectious COVID-19. Number and essential characteristics of COVID-19-associated deaths in Munich during the so-called first wave could be mapped. The interest of physicians in autopsies was rather low despite the appearance of a new infectious disease.