[Results of the introduction of the "mre Netzwerk Nordwest" quality certification for nursing homes in Bonn]. / Ergebnisse der Einführung des "mre-Netzwerk Nordwest"-Qualitätssiegels für Alten- und Pflegeheime in der Bundesstadt Bonn.

BACKGROUND AND OBJECTIVES: The Commission for Hospital Hygiene and Infection Prevention of the Robert Koch Institute (KRINKO) published a Recommendation for Prevention of Infection in Nursing Homes in 2005 [Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (KRINKO)]. The recommended measures for infection control of multidrug-resistant pathogens (MRP) are well known in most institutions. The "mre-Netzwerk Nordwest" quality certification is new, and was implemented by the KRINKO recommendation on a standardized basis for the first time in 2012 in Bonn, Germany. This study describes the first results of this initiative. MATERIAL AND METHODS: The certification contains guidelines based on the above-mentioned KRINKO recommendation and a survey on the status of infections and antibiotic therapies. Nursing homes in Bonn were asked to fulfill a list of ten criteria. The process was supervised by the local health authority and evaluated. RESULTS: Of 38 nursing homes in Bonn, 19 acquired the certification. The survey showed that 1.4% of the residents were treated with antibiotics. Four pathogens were identified as MRP, but did not belong to the classic spectrum. In all, 42% of infections were treated with beta-lactams and 8% with quinolones. The evaluation showed that at least ten urinary tract catheters were removed because of the certification and a related re-evaluation of the indication was made by the treating physician. CONCLUSIONS: Implementation of the certification was assessed as positive, although it involves additional investments. The application of the approach was considered feasible as compared with other regions. The portion of antibiotic therapy use and partly that of other drugs was comparable to the findings of Wischnewski et al., Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 54(11):1147-1152, 2011. Re-assessing the indication for urinary tract catheters might have a positive influence on the prevention of infections. The certification can trigger the exchange of information on MRP and antibiotic stewardship between nursing home physicians.

Severe Serratia liquefaciens sepsis following vitamin C infusion treatment by a naturopathic practitioner.

A 66-year-old female patient developed severe Serratia liquefaciens sepsis following vitamin C infusion treatment by a naturopathic practitioner. The clinical course of the infection was characterized by several complications, and the direct costs of the hospital stay amounted to about 40000 Euro. Genotypically identical S. liquefaciens was isolated from the residue of the infusate given to the patient, as well as from the washbasin overflow and from two other infusion bottles. A careful inspection of the dispensing facilities and review of procedures used to prepare the infusate revealed several indications of poor hygiene. However, the source of contamination could not be fully clarified. This case report raises questions about the local facilities and personal qualifications required for naturopathic practitioners to conduct invasive procedures and demonstrates that lapses in hygiene can lead to severe morbidity and high cost.

[Hemoccult tests of the stool at the time of preventive gynaecological examination (author's transl)]. / Haemoccult-Teststudie im Rahmen der gynäkologischen Vorsorgeuntersuchungen

From January 1, 1977 on, the test for occult blood in the stool becomes, by law, part of routine preventive checkups in order to detect carcinomatous and precancerous lesions of the colon. The effectiveness and practical use of the hemoccult test in the routine gynaecological annual checkup was tested. From October 1975 to June 1976 the test was done in 1,017 women at the time of the preventive gynaecological examinations. The patients received three hemoccult test sachets. They contained guayac resin on filter paper. The stool sample is placed on the filter paper and later tested with peroxide. The patients were informed about the test. The high interest of the patients in the test was exemplified by the high return rate of 80.7%. In 29 patients at least one hemoccult test was found to be positive for a rate of 3.53%. In one of the 821 patients who returned the test a carcinoma of the rectum was discovered which was too high for digital rectal examination. An optimal test is obtained when a stool sample is placed on the filter paper on three consecutive days. When a test is positive the patient is subjected to rectal digital examination, sigmoidoscopy and air contrast barium enema. If the source of bleeding cannot be detected in this manner a coloscopy is done. If the patient followed a diet prior and during the test the rate of positive tests of 3.53% was not increased compared to the group without dietary measures. A special diet prior and during the test is therefore not necessary. The above study shows that the inclusion of the hemoccult test in preventive examinations is a rational extention of preventive testing. Combined with gynaecological preventive examinations, the additional testing for precancerous and carcinomatous lesions of the colon is of additional preventive value for the health of the women.

The separation of 9 S RNA from avian immature red blood cells into f2c-histone mRNA and globin mRNA.

9 S RNA from avian immature red blood cells was isolated from polysome-released ribonucleoprotein particles by sucrose-gradient techniques. Translation of this RNA in an Ehrlich ascites cell-free system and product analysis revealed that globin mRNA was contaminated by f2c-histone mRNA. When 9 S RNA was applied to oligo(dT)-cellulose columns a partial separation could be achieved. Poly (A)-containing globin mRNA did not contain f2c-histon mRNA, whereas the RNA which was not absorbed to oligo(dT)-cellulose contained all the f2c-histone mRNA besides substantial amounts of globin mRNA.