Wanted: The best protection against hospital germs

Enterococci are part of the natural intestinal flora and are harmless for most people. However, the resistant bacteria can become problematic if they get into the blood, urinary tract or wounds and cause infections there. This is particularly the case if the body's own defences are weakened.

The situation becomes more complicated if enterococci are resistant to antibiotics, such as vancomycin. Vancomycin-resistant enterococci (VRE) pose a major risk in hospitals. This is because many risk factors come together here: immunosuppressive therapies, frequent administration of antibiotics that promote resistance and medical interventions that create additional entry points for the pathogens.

If VRE enter the bloodstream, they can trigger a bloodstream infection that can lead to septicaemia. This is an exuberant inflammatory reaction which, in the worst case, leads to multi-organ failure.

New study aims to prevent infections

Preventing these life-threatening VRE bloodstream infections is therefore the be-all and end-all. "PREVENT - Prevention of bloodstream infections with vancomycin resistant enterococci" - is therefore the name of the new project in the Network of University Medicine (NUM). The multi-centre study was initiated by Stefanie Kampmeier. The Professor of Hospital Hygiene specialises in microbiology, virology and infection epidemiology as well as hygiene and environmental medicine. She is also head of the central Hospital Hygiene and Antimicrobial Stewardship unit at Würzburg University Hospital (UKW).

Stefanie Kampmeier is particularly pleased that her PREVENT project is now one of the six studies being funded by the Federal Ministry of Education and Research. This is a great success. Hygiene often leads a shadowy existence, as many people take it for granted. "Who says thank you for not being infected with a multi-resistant pathogen in hospital?" asks Stefanie Kampmeier. But it is not a matter of course. In addition, many factors regarding the cause, development, spread and prevention have not yet been clarified.

More evidence for national recommendations for action

The project manager lists the objectives of PREVENT: "Firstly, we are looking at how often patients in German university hospitals get bloodstream infections caused by VRE. We then investigate which factors influence the risk - from the patients to the pathogen strains to the hospital organisation. We are particularly interested in the influence of hygiene measures and the controlled use of antibiotics on VRE bloodstream infections. We are also analysing which prognostic factors determine the course of the disease in those affected."

Ultimately, the study team hopes to obtain more evidence for the development of national recommendations for the hygienic handling of VRE in hospitals and healthcare facilities.

Different hygiene measures, perceptions and implementations

According to Kampmeier, the Robert Koch Institute's recommendations for action are currently still very generically formulated. Accordingly, the hygiene measures are implemented differently in clinics and hospitals as well as on the individual wards.

"When we talk about hygiene, we tend to mean bundled measures to prevent infection," says Stefanie Kampmeier. This includes, for example, isolating patients if multi-resistant or highly infectious pathogens are detected.

There are also surface disinfection measures, the involvement of patients, for example in hand disinfection, and the wearing of protective clothing such as gowns and gloves. Everyone acts differently. And even if everyone talks about protective clothing, it is not necessarily clear whether the same thing is meant.

Less isolation - more disinfection and monitoring

When Stefanie Kampmeier came to the UKW in July 2023, patients undergoing stem cell transplants and seriously ill people with VRE were isolated. In consultation with the individual clinics, Kampmeier ensured that no one was isolated any more, but that basic hygiene measures and monitoring were intensified. "We have actually seen a drop in bloodstream infections," says Kampmeier happily.

Her reasoning: "If I have to isolate patients with multi-resistant germs and put on full protective equipment every time I come into contact with them, I lose a lot of time that could be better spent on and with the patient. The more often I see the patient, the faster I can react to any deterioration."

The psychological benefits for patients should not be underestimated either. "At the moment, our success is proving us right," says Kampmeier. "But in terms of nationwide inpatient care, there is still a lack of scientific evidence as to which measures really help to prevent VRE infections."

Whole genome sequencing of the pathogens

The pathogens themselves are also to be analysed. Whole genome sequencing will be used to create genetic fingerprints of the pathogens and identify risk profiles in order to derive targeted prevention measures from these. "There are so many exciting aspects that contribute to interdisciplinary infection prevention and should include people and pathogens holistically. This is exactly what makes my and our joint work so appealing," says Stefanie Kampmeier.