You Can Die from a deadly superbugs infection

Andreas H. is 49 when he comes to the Helios Clinic in Duisburg with suspected cancer. Doctors remove part of the pancreas, piercing the abdominal wall in the process. Six weeks later, Andreas has twelve operations behind him. The wounds no longer close, his body is perforated like a sieve. Andreas H. dies with the multi-resistant germs MRSA, VRE and ESBL in the blood. Antibiotics - but actually the magic bullet against everything - had no chance against these super germs.

The 71-year-old Christel B. was in the intensive care unit of the Philippus Foundation in Essen-Borbeck in October 2012. Diagnosis: severe inflammation of the pancreas, triggered by migration of gallstones. After three interventions within three days, she became infected with MRSA. Christel B. is dead two weeks later.

Rainer F. has a heavy smoker's lung and can hardly breathe. In the hospital, the doctors do an incision in the trachea. The files say it went “without complications”. But Rainer F. becomes infected with MRSA, later the intestinal germ VRE is added. A few days later a septic shock, cardiac arrest. At the age of 57.

And then there is Matthias Sammer. At the height of his career in 1997, the professional soccer player had an operation on his left knee, again. This time only a small wrinkle, corrected, everything is fine, said the professor at the Martin Luther Hospital in Berlin. But only a few hours later, the knee began to hurt and became fat. Sammer, already back home, developed a fever. The doctors had no explanation: it doesn't exist. One more look in the knee, and then all that was left was: For God's sake, we've never seen anything like it. No explanation where that came from.

Sammer then spent three weeks in a clinic in Dortmund. It was about his life. “The doctors had difficult conversations with my wife. It wasn't until much later that she told me about it. All the alternatives were horrible. That it would be really good again was the smallest possibility. ”The germs raged in the footballer's body and no antibiotic worked. Then came the last hope, a very last antibiotic. That worked. It saved his life.

That was 1997, and it was the end of footballer Matthias Sammer at the age of 30. To this day he has not been able to jog, says Sammer, even a job as a coach would probably be difficult, two hours a day outside with the team, that could be problematic. Sammer is now the sports director of FC Bayern.

Why does Matthias Sammer talk about his terrible infection?

“It was this very last antibiotic that saved me. I don't want to make headlines, that's the last thing I want. But I'm talking to you because I want to shake things up. Maybe you can help other people with it. "

According to the Federal Ministry of Health in Germany, 7,500 to 15,000 people die every year from infections in hospitals. That alone would be terrible news, because that is as many as all alcohol and drug deaths in a year combined. But the number is likely to be much higher.

ZEIT, ZEITonline, the Funke media group and CORRECTIV have evaluated the billing data of all German hospitals. This shows that doctors bill more than 30,000 times a year for one of the three most common multi-resistant germs MRSA, ESBL or VRE in patients who have died. Whether all these people also died from the germs cannot be read from the data. However, experts are certain that the number of infections is significantly higher than the Ministry of Health indicates.

"There are at least one million infections and more than 30,000 to 40,000 deaths, probably far more," says Professor Walter Popp, Vice President of the German Society for Hospital Hygiene.

Last year, Popp and colleagues scientifically questioned the official version. Popp writes that the figures from the Ministry of Health are far too low and "are largely based on work that was done almost 40 years ago."

A large part of the germs is not only not billed in the clinics, it is not even noticed. Hospitals are not required to report every occurrence of MRSA. According to the Infection Protection Act, only MRSA infections are submitted to the RKI that are found in a laboratory in blood or spinal cord fluid. In addition, only certain risk groups are tested for the germs when they are admitted to the hospital - colonies or infections are often not detected at all.

  • Multi-resistant pathogens are bacteria that can hardly or no longer be treated with antibiotics. The more and the harder antibiotics are used, the more resistances arise. A distinction is made between carriers and infected people. Carriers are colonized with germs, on the skin or on the mucous membranes. If the pathogens get into the bloodstream, it is called an infection. The result: inflammation and blood poisoning. Particularly at risk are people who are often treated as inpatients, who are in need of care, who often take antibiotics, who have catheters in place, chronic wounds or burns.
  • Probably the best known multi-resistant pathogen is MRSA - a methicillin-resistant Staphylococcus aureus. Around one in five Germans now has the germ on their skin. Symptoms are wound infections and inflammation of the airways or blood. A distinction is made between germs from animal fattening (la-MRSA), from the hospital (ha-MRSA), or from the public (ca-MRSA). About ten different epidemic strains are known nationwide.
  • VRE are vancomycin-resistant enterococci. These germs are part of the normal human intestinal flora. If too many antibiotics are used, only resistant enterococci will survive in the end. This can lead to wound and urinary tract infections, abscesses or serious infections. These infections occur particularly in immunocompromised patients.
  • The abbreviation ESBL stands for extended spectrum beta lactamase. These are enzymes that break down certain antibiotics and make them ineffective. ESBL-producing bacteria are resistant to numerous antibiotics. Today these are mainly referred to as MRGN, as multi-resistant gram-negative pathogens. [we have adapted this description a little after feedback from a reader]

There are hardly any numbers that you can rely on. Every statistic says something different. And in view of the large number of settled people, something like perplexity is also spreading among those responsible. “I don't see how we could capture all germs. There are so many people who carry them around with them, ”says Susanne Glasmacher, spokeswoman for the Robert Koch Institute.

It would be a start if at least all infections were recorded centrally. But even that only happens with MRSA, "after all, we have an obligation to report," says Glasmacher. These do not exist with the even more dangerous intestinal germs VRE and the enzyme-producing bacteria ESBL. Often only special reserve antibiotics are effective against these pathogens. Especially very young, old and weak patients die from these germs. And they have been spreading more and more in Germany for years.

German hospitals billed VRE more than 33,000 times in 2013. This includes colonization by patients as well as real infections. Since 2010, the number of VRE diagnoses has increased by 40 percent. The hospitals even billed the group of ESBL germs almost 120,000 times, more than 50 percent more than four years ago. The methicillin-resistant Staphylococcus aureus (MRSA) is still the most widespread in Germany; it is registered almost 140,000 times in German hospitals every year.

For experts like Bernd Beyrle from Techniker Krankenkasse, however, it is clear that these numbers are still far too low. Beyrle heads the inpatient care department at TK. “Not every infection is relevant for billing. We therefore assume that we can probably only detect a third of the infections and colonies here. "

Without an amendment to the Infection Protection Act by the Federal Ministry of Health, the poor data situation will not change. But it doesn't seem in sight. The ministry writes that "several specialized instruments for the detection of multi-resistant pathogens" exist and that checking these is an "ongoing task". In other words: all good, nothing will happen for the time being.

This is an unprecedentedly chaotic state of affairs on such a hot topic.

Anyone who evaluates the billing figures of the health insurance funds district by district quickly sees that the well-known MRSA germ is particularly widespread in the northwest, in Lower Saxony, where the large fattening stalls for the animal industry are also located. The intestinal germ VRE and the germ group ESBL are distributed somewhat more evenly, with a focus on central and eastern Germany. This also corresponds - roughly - to the observations of scientists who have been dealing with the topic for decades.

No reasons for the distribution can be derived from the billing data of the health insurance companies. But they do reveal the size and distribution of the problem.

Multi-resistant pathogens in hospitals

MRSA questionnaire

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The dead

The doctors, Andreas H., operated for the first time on November 30, 2011. Suspected cancer, the chief surgeon removed the left part of the pancreas. In the difficult operation, the stomach wall is pierced. A week later, Andreas had a gastric perforation. The next procedure follows, 48 ​​hours later another. Tracheal incision, artificial respiration. Peritonitis.

It's Christmas and Andreas H. is on the operating table every two days.
Parts of the stomach are cut out, including the spleen. One problem: The doctors cannot seal the wound closures. After the procedures, body secretions run into the abdomen.

Once it is 0.3 liters of milky liquid. And the leaks are increasing. It is repeatedly sewn.

“The previous operations make this step difficult,” says the report on the course of the fourth operation. The patient has seven more in front of him. Open the abdomen, suck off the liquid, rinse, close the abdomen. After a three-hour procedure, a senior physician noted under P.S .: "Due to the numerous previous operations, this procedure was carried out under extremely difficult conditions."

When the wound can no longer be sewn, glue is used.

After a dozen procedures in six weeks, Andreas H.'s stomach is like a sieve. “Every sip he drank ran straight out of him and back into bed,” recalls the mother. But her son wants to live. The weak body is fighting. Slowly, very slowly, things are looking up. The patient comes from the intensive care bed to a normal ward.

“I can get out of here in four weeks,” says Andreas H. on March 17th, 2012. It is his 50th birthday. What relatives and other visitors will experience in the next three months - they cannot get rid of these images to this day.

Once they got a fecal stench when they entered the room. Andreas H. is lying in a tarred chair. Blood is running out of his mouth. He is unable to make himself noticed.

The mother and brother are "totally shocked". You run to the nursing staff and ask for help. Yes, later, but first she has to distribute dinner on the ward, says a sister. After the food has been distributed, the carers collect the leftovers again. Then they take care of Andreas H. and clean him up.

A little later it is clear: Andreas H. was infected with vancomycin-resistant enterococci (VRE). The multi-resistant intestinal bacteria, against which only two antibiotics are effective, are detected in his blood.

The relatives often intervene. It is the mother, who used to be a nurse herself for 26 years, who saves the son from suffocating if he has an acute shortness of breath. Pneumonia and an impending wound ulcer are only investigated at the urging of the family. The protective clothing required for open wounds is seldom worn by the staff despite the relevant advice. The brother complains, asks for “the care and observation that are necessary for recovery”, asks for “close inspection by a senior doctor”.

The mother is slowly losing hope. “At some point during this torture I said goodbye to Andreas,” she says.

On the morning of June 21, 2012, when the phone call came with the news of his death, "I was so glad that God put an end to it".

When he dies, Andreas H. carries the multi-resistant germs MRSA, VRE and ESBL in his blood. This is the case with more and more people. And the hospitals and doctors are to blame for that too.

The doctors

There are two things that only allow the germs to nestle in our midst, to spread, to kill more and more people. Number one: Too much antibiotics. Number two: poor hygiene.

Let's start with the medication. The mechanism is simple. Every living being naturally carries some resistant pathogens when infected. They arise randomly, through natural mutations. If antibiotics are administered, these resistant germs suddenly have an advantage over their non-mutated relatives. The more often antibiotics are administered and the more carelessly they are taken, the higher the likelihood that resistant germs can multiply and spread. Then the drugs are ineffective.

That is why it is so important that antibiotics are only given in an extremely targeted manner. That doctors are required to take an antibiogram before prescribing the medication. To test what the patient is reacting to. That it is monitored and recorded which patient receives which antibiotic for which problem. An antibiotic passport, like vaccination, only holds for antibiotics. And that it is centrally recorded where how many antibiotics are prescribed for what. To optimize the use, throttle. None of that has yet existed.

Even Georg Baum, managing director of the German Hospital Society, calls for restrictive specifications for antibiotic therapy, as is common in neighboring Holland, and a list of prescriptions.

All of this is to prevent the super germs from developing. Doctors, nurses and carers must strictly adhere to hygiene rules to prevent them from spreading further. For example, you need to professionally disinfect your hands. That still happens far too rarely. About two thirds of all patients get the infections in the hospital. Studies show that doctors and nurses only disinfect their hands half as often as they should. That's a huge problem. Not only for the respective patient, but also for everyone else. Because germs spread in the hospital mainly via the staff themselves.

Scientists from Lyon equipped around 450 patients and 350 nurses in a hospital in northern France with sensors that recorded every approach to another person. The scientists created a contact profile for the entire house over a period of nine months. At the same time, they took weekly samples from the nasal mucosa and had them examined for bacteria in the laboratory.

“There is no protected room in a hospital. All bacteria can migrate to almost all rooms and wards, ”says senior scientist Eric Fleury. After a few days or weeks in the hospital, many patients had bacteria in their blood or in their mucous membranes that had actually been brought in by a patient from a completely different ward. 30 percent of the patients were contaminated with multi-resistant bacteria at the end of their stay. "Almost every patient comes into contact with germs from other patients in the house through nurses, doctors or occupational therapists."

The bacteria are spread throughout the home via contaminated gowns, unclean hands, and serving trolleys. Carers meet in the canteen and exchange the bacteria on the skin over shared water carafes and welcoming kisses. At night, nurses and doctors often have to look after several floors at the same time anyway. “Almost everyone has contact with everyone,” says Fleury. A sister comes close to around 100 people in a day.

It is precisely the personnel in hospitals that pose a safety risk for patients. Some epidemiologists, such as the Parisian researcher Didier Guillemot, even refer to doctors and nurses as “superspreaders” - the “greatest possible spreaders” of the deadly bacteria. The only way they could protect their patients is to better sterilize their hands and materials such as blood pressure monitors or first aid vehicles. Guillemot also advocates providing patients with only a few practitioners - not the entire team should come to rounds, but only one doctor and as few nurses as possible. In addition, single rooms are a good protection against high bacterial traffic.

In order to improve disinfection, video cameras hang over the disinfectant dispensers in some hospitals in Holland, for example. This encourages doctors to actually use them. In Germany, hospitals voluntarily take part in studies on the frequency of disinfection. There is no external control, for example with surprising random samples.

It is important that doctors disinfect their hands immediately before coming into contact with the patient. Not in the hallway, not after the treatment, but right next to the patient's bed. Patients can also claim this themselves.

Don't panic: multi-resistant pathogens are not an invisible danger, but an everyday companion. It depends on the visible handling of the problem. Talking about it is not a crime.

Before the stay: Before going to hospital, check with recognized experts for the most important hygiene criteria, for example the German Society for Hospital Hygiene, the Clean Hands campaign or - for expert knowledge - the KRINKO guidelines of the RKI

  • At the beginning of the stay: Find out about hygiene measures right at the beginning of your inpatient stay. Ask for flyers and information on how to properly disinfect your hands. Make your visitors aware of this.
  • Announce: Ask about the nurses or nurses who are responsible for hygiene on the ward. Make yourself known.
  • Self-disinfection: Wash your hands frequently. Disinfect your hands. Note the minimum exposure time for disinfectants. Count slowly to 30. Then the maximum effect of disinfectants is ensured.
  • External disinfection: See if there are disinfectants in your immediate area in your room. This increases the likelihood that these funds will also be used.
  • Doctors and nurses check: Watch the nurses and doctors on the fingers. Immediately before being touched, all personnel should disinfect their hands. Disinfectants must be used before and after, especially for interventions that get under the skin.
  • Cleaning: See if the cleaner is using cleaning items that have not previously been used in isolated rooms.
  • Fresh bed: Insist on a freshly made bed several times a week and a clean environment. Everything that you can reach from bed should be cleaned daily.
  • Fresh air: Get some fresh air. This can also help against germs. Even the World Health Organization recommends natural ventilation.
  • Proper antibiotics: Only take antibiotics when absolutely necessary. Antibiotics are often prescribed unnecessarily. If you need antibiotics, do not stop the therapy under any circumstances, but take the antibiotics to the end as instructed. Half-ingested antibiotics breed multi-resistant germs even more.
  • Note your own isolation: Do you have MDRO or are you infected? Ask about the flyers that provide important information on how to deal with the germ. Observe the disinfection and the rules of isolation. Make your visitors aware of the problem.

Another possibility to contain the super germs: In Holland, every patient without exception is screened for multi-resistant pathogens when they are admitted to the hospital. This is one of the reasons why there are virtually no MRSA patients left there.

Georg Baum, managing director of the German Hospital Association, says: The German clinics would also like to screen every new patient for germs. For this, the Robert Koch Institute would only have to expand the group of patients to be screened. And the health insurance companies would have to pay for it. Baum says that will cost around a billion euros.

“Sometimes we still have three and four-bed rooms with a toilet,” says the hospital representative. His clinics would not even get half of the “generally recognized” six billion euros required. A prophylaxis investment program would be helpful, says Baum.

Baum criticizes the fact that clinics, outpatient doctors and agriculture have not so far been fighting the problem together. Instead, try to blame the other with the germ problem.

It is correct: not only hospitals are to blame for the many deadly pathogens. Also the veterinarians, the insane use of antibiotics in factory farming. Gerd-Ludwig Meyer has recently seen this more and more frequently in Nienburg in southern Lower Saxony. And it makes him more desperate every year.

The animals

“You watch a person suffer miserably. And you can't do anything, absolutely nothing. ”Gerd-Ludwig Meyer runs a dialysis practice with fellow doctors. He tells of the old lady whose urinary tract infection didn't get better during the course of the treatment, it got worse.

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Meyer prescribed the first antibiotic - no effect. He prescribed the second antibiotic, the third, the fourth, the fifth: gentamicin. Tetracycline. Ciprofloxacin. Amoxicillin. There were twenty in all. Nothing helped. After terrible days of agony, the old lady died.

The old woman's death was not an isolated incident. Four more patients have died in Meyer's practice alone in the past few months. Antibiotics hadn't done anything for all four.

“It sucks when you are helpless as a doctor,” says Meyer. He likes to express himself clearly, he is generally a man who quickly creates clarity. At first he was a farmer. As the eldest son, he had taken over the farm. Then this world became too narrow for him. Abitur and medical studies followed.

Meyer's hair is shaggy, you can see life in his face. He describes how he recently noticed that more and more patients had to be isolated because they were infected with germs that no longer respond to antibiotics. And that farmers were suddenly not just piglet breeders and turkey fatteners, but - risk patients. "When a farmer comes to a clinic, he basically has to be quarantined immediately."

Four or five years ago, according to Meyer's perception, things really started. And he quickly realized that there are invisible connections between his two professions: that of the farmer and that of the doctor. And these compounds are called cephalosporins, fluoroquinolones, colistins or carbapenems. These are the names for reserve antibiotics, so to speak, the very last drugs that people use to defend themselves against multi-resistant bacteria in our bodies. The last drugs that can kill these pathogens. But physicians and farmers use the same classes of antibiotics: some on sick animals, others on cattle for slaughter.

What Meyer found in Nienburg is happening more and more frequently across Germany. Doctors at the Münster University Hospital have shown that in many regions almost 80 percent of farmers are colonized with dangerous germs. You wear it on your skin and in the event of a wound or an operation it can enter the bloodstream.

Doctors are finding more and more people infected with a strain of MRSA derived from pig fattening, the CC398. A study that is not yet public shows: More than 30 percent of germ patients at the University Clinic in Münster have pig germs in their bodies, significantly more than in previous studies. The problem: Many of these patients no longer have any direct contact with animals. The germ is therefore already spreading in the population. And the first people are already dying from it.

For a conference in October, the Münster researchers described a patient who lived on a pig farm. She died three weeks after a simple injection in the shoulder. The resistant CC398 had attacked the heart. Another member of a pig farmer family had septic shock after a lung transplant and died of organ failure. Doctors suspect that a relative brought the pig germ into the hospital room.

In Denmark at least five people have died from the germ from the pigsty in recent years. The authorities upheld four cases in a court case, and another case was added this fall. The victims: A 51-year-old patient with blood poisoning, a 63-year-old dialysis patient, an 86-year-old diabetes patient, a 74-year-old with pneumonia in a nursing home.

None of the fatalities in Denmark were linked to pigs themselves.

The experts in Germany observe the same thing: “We also discovered the germ in people who were not in contact with agriculture. The resistant pathogen must already be circulating in the population, ”said Karsten Becker, senior physician at the Münster University Hospital, in an interview with the Swiss Sunday Gazette.

In Germany, most pigsties across Europe are infected with the resistant germ. In some regions, up to 70 percent of the stables are already contaminated, according to the latest studies. In a European comparison, Germany uses the fifth largest amount of antibiotics in meat production. German farmers pump 60 times as much antibiotics into their animals per kilo as Norwegians. A breeding tank for resistant pathogens.

This massive drug distribution is provoked by a structural weakness. In veterinary medicine, doctors are not just doctors, they are also their own pharmacists. They earn money by prescribing large amounts of antibiotics to animals. The scene also calls the big surgeries motorway vets - they drive from farm to farm and sell goods instead of examining and curing animals.

While 26 percent of organically farmed pig populations are colonized with MRSA, researchers from the TH Hannover found animal MRSA in the nose in 92 percent of conventionally kept pigs. And the development continues. The number of farms has decreased from almost 700,000 to less than 300,000 over the past 25 years. The number of fattening pig farms particularly infected by the germs has even shrunk by more than 80 percent, the Federal Ministry of Agriculture reported a few days ago.

All of this contributes to the fact that more and more resistant animal germs develop. And they jump back on people.

Studies show that pathogens are increasingly found even on the meat in the freezer pack. Researchers, who are confronted with developments on a daily basis, sometimes only touch their chicken fillets in the kitchen with rubber gloves so as not to become infected with the animal pathogens.

"The entry of animal germs into hospitals is now more than ten percent in some regions," says Michael Kresken. For Kresken, the development is worrying. And he should know: the professor has been observing resistant germs for half his life.

The future

When Michael Kresken began his life's work with his then boss more than three decades ago, his colleagues laughed at him. Research the resistance of bacteria to antibiotics? What is that supposed to be good for? These numbers, then in the alcohol range, would never increase anyway. The motto back then: A lot helps a lot. Antibiotics, the magic bullet against everything.

When Michael Kresken talks today about the time when antibiotics were still given as prophylaxis, he is doing it as one of the most respected experts on the subject of multi-resistant pathogens. In Rheinbach, at the Bonn-Rhein-Sieg University of Applied Sciences, the professor writes down everything that has to do with resistance under the title “Germap” every two years. In the past few years there has been a steady increase in the number of dangerous pathogens in particular. It is high time for Kresken to finally do something.

“Antibiotics wear out when they are used. The more antibiotics we use, the more resistant strains we select and encourage their spread, ”says Kresken. “These drugs have greatly increased our life expectancy. They are a raw material that we have to protect. "

The experts are particularly concerned about the rarest raw materials, the reserve antibiotics. “General practitioners and internists use a disproportionately large number of broad spectrum antibiotics. This is particularly noticeable in comparison to other countries, ”says Kresken. Broad-spectrum antibiotics clean everything away, they make it easy for doctors - but they also help the resistant pathogens. If the hard antibiotics are already used for small infections, then hardly anything is left to fight the multi-resistant germs that otherwise hardly react to antibiotics.

Wolfgang Witte, 69, was head of the National Staphylococcus Reference Center of the Robert Koch Institute for many years and is considered one of the country's leading MRSA experts. He's a microbiologist, an old school scientist, a slender, cautious man. A visit to the branch of the Robert Koch Institute in Wernigerode quickly turns into a microbiological lesson in which he talks about his great teachers and researchers. He quotes one of them with the words: "The bacteria always have the last word."

The threat posed by antibiotic-resistant germs is an extremely serious issue that can only be countered with scientific reason, he says. He also thinks nothing of mutual blame, for example between medical doctors and veterinarians. Witte is someone who wants to keep track of where the real dangers are. You have to watch how the pathogens change. How they jump back and forth between humans and animals. The now so dangerous animal germs, for example, originally come from humans.

If this continues, the germs will continue to mutate in the animals and form new properties: They could multiply faster and increase their infectious power. They would then come back to the people more dangerous than ever. According to Witte, this could result in a “microbiological apocalypse” that ultimately produces germs against which no medication can help. "If that happens, God help us."

When antibiotics stop working, we have a medieval future in which people die of dental infections and cystitis. The suffering when antibiotics no longer help is unimaginable, for example with sepsis. First comes the fever, then the chills. The vessels widen, the heart rate increases, the skin often marbles or turns blue, blood clotting stops, and finally the blood runs out of all orifices. Necroses form on the extremities, one organ after the other fails.

This medieval future no longer seems that far away. In January 2014, the Federal Office for Risk Assessment reported that E. coli bacteria were detected for the first time in three German pig fattening facilities and a chicken rearing facility, which are even resistant to the reserve antibiotics from the active ingredient group of carbapenems. The carbapenems were always seen as the last hope. The fact that there have recently been germs against which even carbapenems are powerless is bad news.

And who is to blame now?


The meat industry points to the hospitals, who complain about health insurances, the legislature and the outpatient doctors until the problem is back at the meat industry at the door. Clinics neglect hygiene, health insurances do not pay, laws are too lax, outpatient doctors are too clueless and factory farmers give their fattening animals tons of antibiotics. These are the allegations. Still, little is moving.

Germs develop when it is cozy and dark. In Germany, there is currently hardly any need to fear that it will be uncomfortable.

Many of the dangerous germs are not recorded at national level at all. There is no central register for multi-resistant pathogens. While the germs spread internationally across national borders, control in Germany is largely federally organized. Hospitals participate voluntarily in studies referred to by the Federal Ministry of Health.

And those who want to shed light on the darkness also have bad cards. Nobody should know in which hospitals there are how many infections. The hospitals defend themselves with hands and feet against too close supervision. It stays as it is for the germs: cozy and dark.

What to do?

A look across the border.

Take Holland, for example: every patient is screened for multi-resistant germs before they are admitted to the hospital, and if in doubt, they are isolated and remedied before treatment begins. MRSA is therefore practically non-existent in Holland.

Take Denmark as an example: a law is soon to be passed prohibiting children from going out on pig farms. Even though the MRSA numbers in Denmark are low compared to Germany.

Take the USA, for example: In September, President Barack Obama signed an order in which he ordered a whole series of measures. From increased national surveillance of the problem to a $ 20 million prize to develop rapid pathogen tests.

Take France as an example: every hospital receives a visit from a ten-person task force once a year to turn the clinic upside down for 14 days. At the end there is - freely accessible on the Internet - an often 500-page report with grades for individual areas, from A to F. If the results are poor, the houses are threatened with closure.

In Germany, the quality reports from hospitals are as good as worthless. The clinics fill this out themselves, almost all clinics issue a flawless certificate.

The billing data of the health insurance companies, which we also analyzed for this research, could help to improve the quality in the health system. “The aim must be for this data to be made public right down to the hospital level,” says Bernd Beyrle, Head of Inpatient Care at Techniker Krankenkasse.

"After all, the analysis of this data is already an approach to get an idea of ​​the extent at all," says Beyrle. This is exactly what the new Institute for Health Quality, which the federal government is currently planning, will rely on.

According to Beyrle, “a real inspection of hospitals is needed in Germany, as is done in France. And if you don't perform well, you get a warning shot or can even be removed from the market entirely.

It is said that people in the hospital can die. That’s the way it is. But that was also said to women in childbed. Until Ignaz Philipp Semmelweis came up with the idea that doctors have to wash their hands before going to the next patient.

Hygiene is key in the fight against infectious diseases. And a reduced use of antibiotics. If everyone involved were fully committed to combating the deadly germs, perhaps patients like Andreas H., Christel B., and Rainer F. would still be alive today.

CORRECTIV suggests:

The monitoring and control of infections should be organized centrally by the federal government in an infection protection authority. Germs do not stop at national borders. The central authority should not only monitor MRSA infections, it should also take care of VRE, ESBL and other dangerous pathogens.

In addition, as in France, hospitals should be independently controlled. Each department should be assessed separately, for example on a school grade scale. The examiners should post their results on the Internet. If necessary, sloppy houses must be given a warning shot or departments must be closed.

These test results, including the corresponding data and documents, should be posted promptly on the Internet for each individual hospital and should be transparent to the public. If a hospital has serious infection problems and gets a 5 or 6 on hygiene, citizens should know.

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Responsible: David Schraven

Editing: Annika Joeres, Benedict Wermter and Daniel Drepper, in cooperation with ZEIT, ZEITonline and FUNKE media group

Development of the map: Stefan Wehrmeyer

Implementation of the questionnaire: OpenDataCity

Title animation: Ivo Mayr

Art Direction: Thorsten Franke / mediaPolis

Realization: Mr. Jet Lag