[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.