However, much more dramatic developments were observed in the USA [2,3]. There, especially the rates of catheter-associated bloodstream and urinary tract infections, ventilator-associated infections as well as infections with methicillin-resistant S. aureus (MRSA) increased by up to one third in the 2nd quarter of 2020, but then, in contrast to the German figures, did not decrease, but even continued to rise by up to 47% [2]. The president of the Association for Professionals in Infection Control and Epidemiology (APIC) Ann Marie Pettis sees this as a wake-up call and even fears a general step backwards in the fight against hospital infections [5]. Interestingly, however, the increase did not affect all HAIs. C. difficile infections were the only ones that decreased [2] or stayed the same [3] throughout the year. Postoperative wound infections also decreased, at least in the 2nd half of the year [2], which could be due to the postponement of planned operations. Low- and middle-income countries also affected That the increase in HAI rates did not only affect high-income countries is shown by a recent publication using data from India, Mongolia, Jordan, Lebanon, Palestine, Egypt and Turkey [4]. Catheter-associated bloodstream infections were also the most affected by the increase in these countries – overall, the rate increased by 85% in 2020 compared to 2019, while mortality increased by 42% [4]. Nevertheless, all nationally collected data are difficult to compare with each other, because some factors – such as the extent of the first wave or the general equipment of the health care system – differ between all countries, sometimes significantly. More vulnerable patients and bottlenecks in protective equipment While the slump in the number of cases in Germany can easily be explained by the pandemic-induced holding of hospital capacities [1], there is no clear explanation for the percentage increase in NI. Various complex factors play a role here. It is possible that this is due, among other things, to the changed patient clientele, as the COVID 19 patients in the first year of the pandemic were predominantly older, often previously ill people [1-4]. The acute nature and severity of the cases was also reflected in longer length of stay [2,4]. Changes in procedures due to the pandemic as well as initial bottlenecks in protective equipment and excessive demands on staff may also have contributed to the increase. This is suggested by a recent publication based on the experiences of 73 hygiene professionals organised in APIC. Almost 90% stated that they had to implement a crisis standard in the supply of personal protective equipment (PPE) in the early pandemic [6]. This means that respirators, masks and isolation gowns had to be used longer, reused or rationed. In addition, almost 55% reported running out of at least one type of PPE during the pandemic [6]. The study shows that HFCs faced multiple challenges, especially at the onset of the pandemic, such as frequently changing and conflicting guidance, staff turnover, lack of resources to train new staff and increased workload. It is also conceivable that this affected routine surveillance, which may have contributed to higher HAI rates [6]. Conclusion: All in all, the results available so far do not allow any hasty general conclusions to be drawn, for example about inadequate hygiene during the pandemic. Rather, the data underline the importance of comprehensive infection prevention, especially in times of crisis such as the pandemic and in the care of seriously ill patients. It remains to be seen how the trend will develop in the coming years. 18 KNOWLEDGE
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