[Setting up an infection control system].

The present paper deals with the manifestations of nosocomial infections. According to a study by Daschner et al. (18) 4,4% of all hospitalized patients contract nosocomial infections. These have negative effects on the process of recovery and present a great economical burden. The specific problem of hospital infections is compounded of the appearance of polyresistant germs arising from incorrect therapy, the unfavourable immune situation of patients at risk, and the invasive medicotechnical treatment of these patients, such as especially transuretral catheters, intubations, tracheotomies, and the application of venous catheters. As the most important sources of infection the faeces of patients and staff as well as moist places must be mentioned. Germs are transferred from here to the patients predominantly via the hands of the medical staff. An important basis for the improvement of the hygienical situation is provided by infection statistics. This paper presents two and examines them for their significance and feasibility. For model A 500 patients of a medical intensive ward were analysed prospectively in summer 1978. Besides microbiological data a great number of patients' parameters such as disposition, kind and quality of medical operations etc. were taken into account. For model B the microbiological findings of 3952 patients of 4 intensive wards were compiled retrospectively. Results of the comparison: Model A is indispensable for defined questions in the area of hospital hygiene, but requires considerable efforts in terms of time and money. Model B can be employed for the longterm control of the frequencies of infection and changes of resistance from already existing reports and does not require considerable additional means. In view of the extensive material it is advisable to process the data electronically. Results of the infection statistics (Modell B): An average infection rate of 16% was determined. Most frequent were infections of the respiratory tract (43%) followed by infections of the urinary tract (29%), blood (13%) and wounds (14%). The most important germs were fungi, Pseudomonas, E. coli, Klebsiella, Proteus, Enterococci, Staph. aureus, and Staph. albus. In the discussion the results are compared with findings in the current literature. Special attention is given to the definition of the terms infection and hospital infection and other problems influencing comparability. In a final statement the importance of environmental examinations and the role of pathology for infection control are treated.