An appeal for strengthening genomic pathogen surveillance to improve pandemic preparedness and infection prevention: the German perspective.

The SARS-CoV-2 pandemic has highlighted the importance of viable infection surveillance and the relevant infrastructure. From a German perspective, an integral part of this infrastructure, genomic pathogen sequencing, was at best fragmentary and stretched to its limits due to the lack or inefficient use of equipment, human resources, data management and coordination. The experience in other countries has shown that the rate of sequenced positive samples and linkage of genomic and epidemiological data (person, place, time) represent important factors for a successful application of genomic pathogen surveillance. Planning, establishing and consistently supporting adequate structures for genomic pathogen surveillance will be crucial to identify and combat future pandemics as well as other challenges in infectious diseases such as multi-drug resistant bacteria and healthcare-associated infections. Therefore, the authors propose a multifaceted and coordinated process for the definition of procedural, legal and technical standards for comprehensive genomic pathogen surveillance in Germany, covering the areas of genomic sequencing, data collection and data linkage, as well as target pathogens. A comparative analysis of the structures established in Germany and in other countries is applied. This proposal aims to better tackle epi- and pandemics to come and take action from the "lessons learned" from the SARS-CoV-2 pandemic.

Infection control strategies for healthcare workers during COVID-19 pandemic in German hospitals: A cross-sectional study in march–april 2021

Background Healthcare workers (HCW) are at risk of getting infected with COVID-19 at work. To prevent such incidents and provide a safe environment in hospitals, comprehensive infection control strategies are necessary. We aimed to collect information on COVID-19 infection control strategies regarding personal protective equipment (PPE), regulations during breaks for HCW and dissemination of pandemic-related information. Methods We invited infection control practitioners from 987 randomly selected German hospitals in March–April 2021 to participate in our cross-sectional online survey. We categorized the hospital based on bed capacity (≤499 beds = small;≥500 beds = large). Fisher's exact test was performed and p < 0.05 defined as statistically significant. Findings 100 participants completed the questionnaire. Small hospitals were more directive about requiring FFP2 respirators (63%), whereas larger hospitals more often gave their HCW a choice between these and medical masks (67%). For the care of COVID-19 and suspected COVID-19 cases, >90% of the participants recommended the use of gloves. Notably, gloves were recommended beyond COVID-19 in 30% of the hospitals. During meal breaks various strategies were followed. Conclusion Recommendations for PPE varied across hospital sizes, which could be due to different assessments of necessity and safety. Regulations during breaks varied strongly which illustrates the need for clear official guidelines.

Infection control strategies for healthcare workers during COVID-19 pandemic in German hospitals: A cross-sectional study in march-april 2021.

Background: Healthcare workers (HCW) are at risk of getting infected with COVID-19 at work. To prevent such incidents and provide a safe environment in hospitals, comprehensive infection control strategies are necessary. We aimed to collect information on COVID-19 infection control strategies regarding personal protective equipment (PPE), regulations during breaks for HCW and dissemination of pandemic-related information. Methods: We invited infection control practitioners from 987 randomly selected German hospitals in March-April 2021 to participate in our cross-sectional online survey. We categorized the hospital based on bed capacity (≤499 beds = small; ≥500 beds = large). Fisher's exact test was performed and p < 0.05 defined as statistically significant. Findings: 100 participants completed the questionnaire. Small hospitals were more directive about requiring FFP2 respirators (63%), whereas larger hospitals more often gave their HCW a choice between these and medical masks (67%). For the care of COVID-19 and suspected COVID-19 cases, >90% of the participants recommended the use of gloves. Notably, gloves were recommended beyond COVID-19 in 30% of the hospitals. During meal breaks various strategies were followed. Conclusion: Recommendations for PPE varied across hospital sizes, which could be due to different assessments of necessity and safety. Regulations during breaks varied strongly which illustrates the need for clear official guidelines.

[Establishment of genomic pathogen surveillance to strengthen pandemic preparedness and infection prevention in Germany]. / Etablierung der Genomischen Erreger-Surveillance zur Stärkung des Pandemie- und Infektionsschutzes in Deutschland.

The SARS-CoV­2 pandemic has shown a deficit of essential epidemiological infrastructure, especially with regard to genomic pathogen surveillance in Germany. In order to prepare for future pandemics, the authors consider it urgently necessary to remedy this existing deficit by establishing an efficient infrastructure for genomic pathogen surveillance. Such a network can build on structures, processes, and interactions that have already been initiated regionally and further optimize them. It will be able to respond to current and future challenges with a high degree of adaptability.The aim of this paper is to address the urgency and to outline proposed measures for establishing an efficient, adaptable, and responsive genomic pathogen surveillance network, taking into account external framework conditions and internal standards. The proposed measures are based on global and country-specific best practices and strategy papers. Specific next steps to achieve an integrated genomic pathogen surveillance include linking epidemiological data with pathogen genomic data; sharing and coordinating existing resources; making surveillance data available to relevant decision-makers, the public health service, and the scientific community; and engaging all stakeholders. The establishment of a genomic pathogen surveillance network is essential for the continuous, stable, active surveillance of the infection situation in Germany, both during pandemic phases and beyond.

[COVID-19 vaccination strategy for employees of German hospitals: results of a survey of infection control practitioners within the B-FAST project]. / COVID-19-Impfstrategien für Beschäftigte deutscher Kliniken: Ergebnisse einer Befragung von Leitungen der (Krankenhaus­)Hygiene im Rahmen des B-FAST-Projektes.

BACKGROUND AND AIM: At the beginning of the COVID-19 vaccination campaign in Germany, employees in medical facilities were prioritised for vaccination against SARS-CoV­2 due to the high risk of exposure and contact with vulnerable groups. Hospitals were therefore encouraged to organise and implement the vaccination of their employees as soon as possible. The aim of the study was to record the practice regarding the vaccination strategy for employees in German hospitals. METHODS: In a self-developed cross-sectional study, infection control practitioners of all German university hospitals as well as non-university hospitals in Lower Saxony and Bavaria were surveyed in March 2021. The data were stratified according to the characteristics of university hospitals and non-university hospitals. RESULTS: Of 416 invitations sent out, 100 questionnaires (university hospitals: 33; non-university hospitals: 67) were completed. University hospitals reported greater vaccination capacity than non-university hospitals, but a limiting factor was uncertain vaccine supply. Vaccination information campaigns were planned or had already been conducted in 89% of clinics. About two-thirds of the respondents (70%) said they did not plan to conduct antibody tests on vaccinated employees. A follow-up of vaccinated employees to detect possible SARS-CoV­2 infections by PCR was planned by 41% of the respondents. In case of detection of SARS-CoV­2 infection, 72% of the respondents had planned further diagnostic procedures. DISCUSSION: All hospitals were able to achieve rapid implementation of COVID-19 vaccination of their employees. At the time of the survey, there was also much uncertainty regarding the management of breakthrough infections as well as the need for booster vaccinations.

SARS-CoV-2 surveillance and testing: results of a survey from the Network of University Hospitals (NUM), B-FAST.

Background: The B-FAST project of the National University Network (NUM) examines and records applied surveillance strategies implemented in hospitals i.a., to protect patients and employees from SARS-CoV-2 infection. Methods: Infection control physicians in German university hospitals (UK), as well as non-university hospitals (NUK; Bavaria, Lower Saxony) were surveyed in March 2021 regarding SARS-CoV-2 testing/surveillance strategies in a cross-sectional study using a standardized online questionnaire. The focus was on screening strategies taking into account the "test" methods used (case history, PCR, antigen, antibody test). Results: The response rate was 91.7% (33/36) in UK and 11.3%-32.2% in NUK. Almost all hospitals (95.0%) performed a symptom and exposure check and/or testing upon inpatient admission. Non-cause-related testing (screening) of health care workers in COVID wards was preferably done by PCR in UK (69.7% PCR; 12.1% antigen), while NUK (29.9% PCR; 49.3% antigen) used antigen testing more frequently. Regardless of the type of facility, about half of the respondents rated the benefit of screening higher than the effort (patients: 49%; employees: 45%). Conclusion: Testing/surveillance strategies find a high level of acceptance at German hospitals and are generally carried out in accordance with the national testing strategy with differences depending on the level of care.

Infection surveillance measures during the COVID-19 pandemic in Germany.

Introduction: To address the question as to which infection surveillance measures are used during the ongoing COVID-19 pandemic in Germany and how they differ from pre-existing approaches. Methods: In accordance with the systematic approach of a scoping review, a literature search was conducted in national and international medical literature databases using a search string. The search in the databases was limited to the period from 01.01.2000 to 15.11.2020 and has been subsequently completed by hand search until 08.03.2021. A hand search, even beyond 15.11.2020, seemed necessary and reasonable, since due to the dynamics of the ongoing COVID-19 pandemic, a large number of articles and regulations are being published very quickly at short notice. Results: The literature search resulted in the following number of hits in the databases listed below: PubMed: 165 articlesCochrane: 1 review and 35 studiesWeb of Science: 217 articlesRobert Koch Institute: 49 articles Thus, a total of 467 hits were identified, with a total of 124 hits being duplicates. From these, 138 articles were considered relevant to the COVID-19 infection surveillance situation in Germany based on established criteria. After reading the full texts, 92 articles and websites were ultimately included in the scoping review. Discussion: Many of the lessons learned from previous outbreaks seem to have been implemented in the infection surveillance measures during the ongoing COVID-19 pandemic in Germany. Most of the changes compared with previous measures were based on technological streamlining of existing procedures and changes and more inclusion of the population in different infection surveillance measures.