BACKGROUND:The newly proposed surveillance entity hospital-onset bacteraemia (HOB) is associated with significant morbidity, mortality and costs. Identifying and understanding risk factors is crucial for the development of reliable risk prediction models to guide targeted infection prevention and control strategies. AIM:The aim of the present study was to identify and classify risk factors for the onset of HOB in the general patient population in Organisation for Economic Co-operation and Development countries. METHODS:We conducted an umbrella review to synthesize the evidence from systematic reviews and meta-analyses. We searched CINAHL, PubMed, Cochrane Library, Web of Science and grey literature. Two researchers independently screened abstracts and full texts, extracted data and assessed quality with AMSTAR 2. Data were analysed descriptively. Risk factors were categorized according to whether they can be modified through infection prevention and control interventions. FINDINGS:We included 19 systematic reviews and identified 43 risk and five protective factors, which we categorized into patient-related (e.g. prior bloodstream infection (odds ratio (OR) = 6.56, P = 0.004), male sex (OR = 2.18, confidence interval (CI) = 1.52-3.12), multiple comorbidities (OR = 1.66, CI = 1.35-2.49), smoking (OR = 1.26, CI = 1.01-1.57)), procedure-related (e.g. red blood cell transfusion (risk ratio (RR) = 4.82, CI = 2.9-8.08)) and setting-related (e.g. single room (RR = 0.64, CI = 0.53-0.76)). CONCLUSION:Most of the risk factors identified are well recognized for Central Line-Associated Bloodstream Infection and plausible contributors to HOB. Although not all HOB incidents are preventable, an early identification of high-risk patients combined with risk-stratified targeted interventions can prevent cases and improve outcomes. To ensure real-world applicability with algorithmic support, relevant data must be automatically available, and changeable factors should be monitored. PROTOCOL AND REGISTRATION:The review is registered in International Prospective Register of Systematic Review, and the protocol can be found under CRD42023480112.

Linking project data and data from routine clinical practice with healthcare-related data is essential for German healthcare research in order to answer complex questions validly and efficiently. Currently, fragmented data sources, heterogeneous legal requirements, and a lack of infrastructure prevent the optimal use and linking of these data. The Network University Medicine (NUM) is therefore developing a dedicated data infrastructure to link primary study data and routine clinical data with external healthcare-related data (e. g., data from statutory and private health insurance companies, data from cancer registries of the federal states, and data from registration offices). The position paper describes the various data worlds, including examples from epidemiological and clinical research that illustrate the added value and challenges of data linkage. In particular, it presents the new structures of the data acceptance and processing center (DAAeD) in the NUM, which is intended to enable quality-assured, data protection-compliant receipt and linkage of data. Standardized application and approval procedures as well as innovative privacy-preserving record linkage procedures are central to this. International experience, including from Scandinavia and the UK, demonstrates the benefits of such infrastructures for research and healthcare. In conclusion, we advocate rapid political and institutional implementation of the recommendations described in order to make health research in Germany competitive in international comparison and to ensure sustainable, patient-centered health care.

BACKGROUND:The COVID-19 pandemic was challenging in terms of the mental health of the population and the provision of mental health services. AIMS OF THE STUDY:To gain insights from the pandemic for an improved pandemic and crisis preparedness for the future. MATERIAL AND METHODS:Recommendations are derived from the results of reviews on mental health and psychiatric psychotherapeutic care during the pandemic. RESULTS:Large sections of the population proved to be resilient in terms of mental health. Populations at risk showed increased stress, particularly children, adolescents, women, people with low socioeconomic status, people in nursing homes and healthcare workers. People with long/post-COVID were also particularly affected. At the same time there were significant restrictions on the provision of psychiatric psychotherapeutic care, particularly in the inpatient sector. Insufficient current data on the mental health of the population and a lack of surveillance of service utilization, despite an existing data basis, made it difficult for timely detection of stress and care restrictions and an adequate response for crisis management. The rigid sectorization of the mental healthcare system often prevented alternative outpatient care. DISCUSSION:The national mental health surveillance should be continued and further developed. Structures should be provided for the time-sensitive consolidation of data and the multiprofessional generation of recommendations in order to be able to detect and respond to challenges due to bottlenecks in the provision of care and stress in risk groups. Flexible, cross-sectoral mental healthcare should be made possible throughout Germany.

Die COVID-19(„coronavirus disease 2019“)-Pandemie war herausfordernd bezüglich der psychischen Gesundheit der Bevölkerung und der psychiatrisch-psychotherapeutischen Versorgung. Erkenntnisse aus der Pandemie für eine verbesserte Vorbereitung auf zukünftige Krisen („pandemic and crisis preparedness“) gewinnen. Aus den Ergebnissen von Reviews zu psychischer Gesundheit und psychiatrisch-psychotherapeutischer Versorgung in der Pandemie werden Empfehlungen abgeleitet. Große Teile der Bevölkerung erwiesen sich in ihrer psychischen Gesundheit als resilient. Risikopopulationen zeigten erhöhte Belastungen, insbesondere Kinder, Jugendliche, Frauen, Menschen mit niedrigem soziökonomischem Status, Menschen in Heimen sowie Gesundheitspersonal. Besonders betroffen waren auch Menschen mit Long‑/Post-COVID. Gleichzeitig kam es zu signifikanten Einschränkungen der psychiatrisch-psychotherapeutischen Versorgung, insbesondere im stationären Bereich. Eine unzureichende aktuelle Datenlage zu psychischer Gesundheit und fehlende Versorgungssurveillance – trotz existierender Datengrundlage – erschwerte die rechtzeitige Detektion von Belastungen und Versorgungseinschränkungen sowie adäquate Reaktionen zur Krisenbewältigung. Die starre Sektorisierung des Versorgungssystems verhinderte vielfach eine alternative ambulantisierte Versorgung. Die Nationale Mental Health Surveillance sollte weitergeführt und -entwickelt werden. Es sollten Strukturen zur zeitsensitiven Zusammenführung von Daten sowie multiprofessionellen Generierung von Empfehlungen vorgehalten werden, um Versorgungsengpässe und Belastungen von Risikogruppen detektieren und darauf reagieren zu können. Flexible, sektorübergreifende Versorgung sollte deutschlandweit ermöglicht werden.

Background: Integrated genomic surveillance (IGS), i.e. the integrated analysis of pathogen whole genome sequencing and classical epidemiological data, can contribute substantially to the disease surveillance and infection prevention activities of local public health authorities (LPHAs). Aim: Our aim was to characterise how LPHAs use IGS, and factors required or important for their implementation, in the context of the German public health system. Methods: We employed a mixed-methods design combining a quantitative survey of 60 LPHAs in three German states with five qualitative case studies based on LPHAs in four German localities and one state-level public health authority. Results: Approximately half of LPHAs reported adoption of IGS; applications included outbreak analysis (n = 25), targeting and evaluation of infection control measures (n = 25 and n = 18, respectively) and characterisation of pathogen transmission chains (n = 25). Factors identified as required or important for the implementation of IGS in LPHAs included fast sample-to-result turnaround times, organisational data interpretation capabilities and clearly defined surveillance sampling strategies. Based on the case studies in which the adoption of IGS was successful, we formulate recommendations for implementing IGS at the level of LPHAs, including establishment of dedicated IGS analysis teams within LPHAs, use of user-friendly digital solutions (e.g. browser-based dashboards) for data exchange and analysis, and implementation of IGS in collaboration with local academic institutions. Conclusion: Our analysis paves the way for increasing the implementation of IGS by LPHAs in Germany and other countries with similarly structured public health systems.

Die aktualisierte S1-Leitlinie der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin gibt Empfehlungen zur Hygiene bei zentralen und peripheren Regionalanästhesieverfahren, um das Infektionsrisiko für Patientinnen und Patienten so gering wie möglich zu halten. Im Mittelpunkt steht die konsequente Umsetzung standardisierter Hygienemaßnahmen, wobei der sorgfältigen Händehygiene der Behandler vor und nach jedem Eingriff eine zentrale Bedeutung zukommt. Die Vorbereitung der Patientenoberfläche erfolgt, sofern keine sichtbare Verschmutzung vorliegt, direkt mit remanenzhaltigen, alkoholbasierten Desinfektionsmitteln. Eine Haarentfernung wird nur bei Notwendigkeit und vorzugsweise mit Clippern empfohlen. Für alle neuroaxialen Verfahren sind das Tragen von Mund-Nasen-Schutz, Haube und sterilen Handschuhen verbindlich vorgesehen, während bei einzeitigen peripheren Blockaden ggf. medizinische Einmalhandschuhe ausreichend sein können. Es wird ausschließlich mit sterilen Einmalmaterialien und frisch entnommenen Medikamenten gearbeitet, um Kreuzkontaminationen zu verhindern. Für ultraschallgeführte Techniken ist die sterile Abdeckung des Schallkopfs sowie die sorgfältige Desinfektion der Sonde vor und nach Gebrauch obligatorisch. Liegende Regionalanästhesiekatheter erfordern eine tägliche Kontrolle der Einstichstelle; ein Verbandswechsel sollte jedoch nur bei Verdacht auf Infektion oder erkennbarem Bedarf erfolgen. Tunnelung und chlorhexidinhaltige Verbände können zur Reduktion der bakteriellen Kontamination beitragen. Beim Auftreten von Infektionszeichen sind ggf. eine gezielte Diagnostik und eine an die Schwere der Infektion angepasste Therapie einzuleiten. Ergänzend empfiehlt die Leitlinie die Einführung von Hygiene-Bundles, standardisierten Sets und regelmäßigen Schulungen, während die Maßnahmen durch strukturiertes Monitoring und Benchmarking kontinuierlich evaluiert und verbessert werden sollten. Die Empfehlungen sind an die jeweiligen lokalen Gegebenheiten sowie einrichtungsbezogene Hygienepläne anzupassen.

Healthcare-associated infections (HAI) are a significant burden to patients, hospitals, health systems and society. Infection prevention and control measures are well established and evidence-based, however, no detailed risk assessment is included aiming at personalized IPC measures. In preparation of an individual risk assessment application for decision support for hospital-onset bloodstream infections (HOBSI), we present initial findings of re-analyses of a dataset including 4290 patients from a large study. We applied logistic regression modeling and a random forest approach to identify candidate risk parameters available in routine hospital data.

The updated S1 guideline from the German Society of Anesthesiology and Intensive Care Medicine provides recommendations on hygiene practices for central and peripheral regional anesthesia procedures, aiming to minimize the infection risk for patients. Central to the guideline is the consistent implementation of standardized hygiene measures, with particular emphasis on thorough hand hygiene by the practitioners before and after each procedure. Patient skin preparation should be performed directly with remanent, alcohol-based disinfectants, provided there is no visible contamination. Hair removal is recommended only when necessary, preferably using clippers. For all neuraxial procedures, the use of a face mask, head cover, and sterile gloves is mandatory. In the case of single-shot peripheral nerve blocks, the use of non-sterile disposable gloves may be acceptable depending on the circumstances. Only sterile single-use materials and freshly withdrawn medications from single-dose containers should be used to prevent crosscontamination. In ultrasound-guided procedures, the use of a sterile probe cover and thorough disinfection of the ultrasound transducer before and after use are obligatory. For indwelling regional anesthesia catheters, the insertion site must be inspected daily; dressing changes should be performed only when infection is suspected or when there is an evident clinical indication. Catheter tunneling and the use of chlorhexidine-containing dressings may contribute to reducing bacterial contamination. If signs of infection occur, targeted diagnostics and infection-specific treatment should be initiated, according to the severity of the clinical presentation. Additionally, the guideline recommends the introduction of hygiene bundles, standardized procedural kits, and regular staff training. These measures should be subject to continuous evaluation and optimization via structured monitoring and benchmarking. All recommendations must be adapted to local conditions and institution-specific hygiene protocols.

Background Hand disinfection is often omitted during emergencies because it may delay life-saving treatments. As healthcare-associated infections significantly worsen patient outcomes, the categorical omission of hand disinfection in emergencies should be re-evaluated. Real-world observations on this subject tentatively indicate compliance rates of <10%. In an adult simulation study, we have previously shown that proper hand disinfection without delaying patient care is feasible in >50% of scenarios. However, no comparable data have been published regarding emergencies in infants or children. Aim This observational study aimed to assess the feasibility of hand disinfection in simulated paediatric patients requiring advanced life support (PALS). Methods We observed 32 simulations of life-threatening conditions. Two observers counted all possible moments for administering hand hygiene, according to the World Health Organization protocol, and assessed them for time-neutral feasibility. Results In the 32 scenarios, the feasibility of hand disinfection for all WHO moments ranged from 78.3 to 100%. Of all 573 hand disinfection moments, 552 (96.3%) were deemed feasible.Altogether 208 (36.3%) occurred before aseptic tasks. Of these, 187 (89.9%) were considered feasible. Hand disinfection for WHO-2 moments feasibility showed to be at least 50% in the cases. A total of 189 (90.9%) of all WHO-2 hand disinfections were applied by the role of the “iv-manager”. Scenarios with shockable rhythms and peri-arrest showed higher feasibility ratios than those without. Conclusions The categorical omission of hand disinfection in PALS seems to be no longer acceptable or appropriate. The feasibility of hand hygiene should be re-evaluated in real-world scenarios.

BACKGROUND:Traditional infection prevention and control (IPC) education and training of healthcare workers (HCWs) is expensive and rarely sustainable. Gamification strategies support behavioural change by capitalizing on psychological drivers such as intrinsic and extrinsic motivation. However, little is known about which type of reward presentation best supports the engagement of HCWs. AIM:To examine which reward strategy can best facilitate engagement and acquisition of IPC knowledge. METHODS:This study was performed in three gastroenterology wards, and a palliative care ward served as the control. Data on bed occupancy and consumption of alcohol-based hand sanitizer (ABHS) were collected over a 2-month baseline period, and the number of correct answers was gathered during the intervention phases. Surveys on expectation and satisfaction were conducted pre and post intervention. Twice-weekly knowledge quizzes used loss aversion, standard reward and in-game reward strategies. Multi-variate analysis was used to analyse data on ABHS consumption and IPC knowledge. FINDINGS:In total, 105 HCWs participated in this study. A 170% increase in mean ABHS consumption was observed between baseline and the last phase of gamification. This represents a significant effect of gamification (P<0.05). However, no significant difference in ABHS consumption was observed between the gamified wards (P>0.05). Furthermore, gamified strategies showed higher engagement than the control strategy, but strategies of loss aversion and standard rewards did not display higher ABHS consumption or game engagement compared with gamification alone. CONCLUSION:The intervention effectively engaged medical and non-medical staff in IPC topics, positively influencing HCW work flow and increasing ABHS consumption. These findings highlight gamification as a promising approach for IPC education.

In acute crises such as the COVID-19 pandemic, scientific questions need to be addressed quickly in order to protect the health of the population and to maintain the function of the healthcare system. The prevailing urgency and the large number of issues to be addressed, combined with the limitation of time, personnel, or monetary resources make prioritization indispensable. In the COVID-19 Evidence Ecosystem (CEOsys) project initiated by the University Medicine Network (NUM), a procedure for the rapid prioritization of questions was used specifically for evidence syntheses and clinical guideline recommendations, which was further developed in the follow-up project PREparedness and Pandemic Response in Germany (PREPARED). The result is a concept paper on the prioritization of research questions and topics with a more generic orientation. The content of the concept is presented in this article. The core subjects are basic principles of successful prioritization as well as an explicit seven-step process with information on organizational framework conditions and the procedure. The concept offers possibilities for adaptation, as research prioritization is highly context-dependent. The application of such a systematic, transparent prioritization process contributes to comprehensible and informed decisions about which research questions are relevant and urgent, in which order they should be processed, and which issues are not critically urgent or have to be postponed.

BACKGROUND:Infection prevention and control (IPC) is inherently sustainable by reducing avoidable infections and subsequent interventions. AIM:To encompass the perspectives of a binational multi-disciplinary group of experts based on a workshop on the capabilities, opportunities and motivations needed to overcome key barriers to the successful implementation of even more sustainable IPC with regard to ecological sustainability. METHODS:The 16 workshop participants were divided into groups to discuss three different issues regarding the most sustainable IPC following the World Café method. Carrying out a content analysis, the results were categorized into common themes - first for each question and then overall - and those categories were mapped into the Capability, Opportunity, Motivation and Behaviour (COM-B) model. FINDINGS:Five intervention functions were identified across two sources of behaviour of the COM-B framework, whereby 10 of the 16 categorized interventions could be initiated directly by the IPC practitioners, whilst others need to be led by the hospital management. A recurring theme was the need for a well-structured, high-quality database that weighs patient safety and sustainability at the source of any intervention. CONCLUSION:While a top-down approach is essential in parts, various interventions can also be initiated and led directly by IPC practitioners. In addition, to ensure sustainable and lasting changes in practice, there needs to be structured and comprehensive data collection. These results add valuable information for healthcare facilities and IPC practitioners who want to become more environmentally-friendly.

Establishing population-based cohorts is indispensable for effective epidemic prevention, preparedness and response. Existing passive surveillance systems face limitations in their capacity to promptly provide representative data for estimating disease burden and modelling disease transmission. This perspective paper introduces a framework for establishing a dynamic and responsive nationally representative population-based cohort, with Germany as an example country. We emphasise the need for comprehensive demographic representation, innovative strategies to address participant attrition, efficient data collection and testing using digital tools, as well as novel data integration and analysis methods. Financial considerations and cost estimates for cohort establishment are discussed, highlighting potential cost savings through integration with existing research infrastructures and digital approaches. The framework outlined for creating, operating and integrating the cohort within the broader epidemiological landscape illustrates the potential of a population-based cohort to offer timely, evidence-based insights for robust public health interventions during both epidemics and pandemics, as well as during inter-epidemic periods.

Early outbreak detection, allowing rapid intervention, is essential to reduce the burden of healthcare-associated pathogen transmission, including multidrug-resistant bacteria. Digital, routine data-driven solutions are promising, but often proprietary, non-interoperable, or limited in functional scope. The open-source Smart Infection Control System (SmICS) offers automatic calculations and interactive views on patients' movement and lab data, epidemic curves, contact networks, complemented by temporal-spatial visualizations. It is an open-source software based on openEHR as an interoperability standard and was evaluated by assessing time efficiencies in performing basic infection control tasks (e.g., contact networks) and usability with the System Usability Scale (SUS). Evaluated at three sites, SmICS reduced the time needed for performing routine infection control tasks by up to 81.47% (68.5 min (95%CI [30.5–106.5])) reaching a SUS of 51.6 points. The study reveals time savings through the use of SmICS in daily tasks, but also identified usability issues and a need for minimizing query waiting times.

SARS-CoV-2 Omicron onset resulted in the rapid displacement of Delta and subsequent intra-Omicron displacement-events. Evidence of geographical diversity on the dynamics is present between and within countries. Considering Omicron’s immune-evasive potential compared to earlier variants, we investigated whether vaccines have influenced local dominance patterns in Germany. We used weekly-binned genomic surveillance-data representing 48 regional outbreaks with as many displacement-events. Displacement occurred when a given variant constituted ≥ 50

Data visualization methodologies were intensively leveraged during the COVID-19 pandemic. We review our design experience working on a set of interdisciplinary COVID-19 pandemic projects. We describe the challenges we met in these projects, characterize the respective user communities, the goals and tasks we supported, and the data types and visual media we worked with. Furthermore, we instantiate these characterizations in a series of case studies. Finally, we describe the visual analysis lessons we learned, considering future pandemics.

Während einer Pandemie muss Resilienz nicht nur als Eigenschaft des Gesundheitssystems, sondern auch des umgebenden Forschungsumfelds betrachtet werden. Um verlässliche, evidenzbasierte Empfehlungen aus der Universitätsmedizin an die Gesundheitspolitik und die Entscheidungsträger bereitstellen zu können, müssen wissenschaftliche Erkenntnisse schnell, integrativ und multidisziplinär generiert, synthetisiert und kommuniziert werden. Die Resilienz der öffentlichen Gesundheitssysteme und der Gesundheitsforschungssysteme sind somit eng verknüpft. Die Reaktion auf die SARS-CoV-2-Pandemie in Deutschland wurde jedoch durch das Fehlen einer adäquat vernetzten Gesundheitsforschungsinfrastruktur erschwert. Das Netzwerk Universitätsmedizin (NUM) wurde zu Beginn der Pandemie mit dem Ziel gegründet, Deutschland auf zukünftige Pandemien vorzubereiten. Ziel des Projektes "PREparedness and PAndemic REsponse in Deutschland (PREPARED)" ist es, ein ganzheitliches Konzept für eine kooperative, adaptierbare und nachhaltige Gesundheitsforschungsinfrastruktur innerhalb des NUM zu entwickeln und damit einen Beitrag zu einer umfassenden Pandemiebereitschaft zu leisten. Das vorgeschlagene Konzept dieser Infrastruktur vereint vier Kern- und drei Unterstützungsfunktionalitäten in vier verschiedenen Handlungsfeldern. Die Funktionalitäten gewährleisten im Falle zukünftiger Gesundheitskrisen ein effizientes Funktionieren des Gesundheitsforschungssystems und eine rasche Übertragung entsprechender Implikationen in andere Systeme. Die vier Handlungsfelder sind (a) Monitoring und Surveillance, (b) Synthese und Transfer, (c) Koordination und Organisation sowie (d) Kapazitäten und Ressourcen. Die sieben Funktionalitäten umfassen 1) eine Monitoring- und Surveillance-Einheit, 2) eine Pathogenkompetenz-Plattform, 3) Evidenzsynthese und vertrauenswürdige Empfehlungen, 4) eine Einheit zur regionalen Vernetzung und Implementierung, 5) eine Strategische Kommunikationseinheit, 6) Human Resources Management und 7) ein Rapid Reaction & Response (R3)-Cockpit. Die Governance wird als Kontroll- und Regulierungssystem eingerichtet, wobei agile Management-Methoden in interpandemischen Phasen trainiert werden, um die Reaktionsfähigkeit zu verbessern sowie die Eignung agiler Methoden für die wissenschaftliche Infrastruktur für die Pandemiebereitschaft zu untersuchen. Der Aufbau der PREPARED-Forschungsinfrastruktur muss vor der nächsten Pandemie erfolgen, da Training und regelmäßige Stresstests grundlegende Voraussetzungen für deren Funktionieren sind.During a pandemic, resilience must be considered not only as an attribute of the health care system, but also of the surrounding research environment. To provide reliable evidence-based advice from university medicine to health policy and decision makers, scientific evidence must be generated, synthesized and communicated in a rapid, integrative and multidisciplinary manner. The resilience of public health systems and the health research systems are thus closely linked. However, the response to the SARS-CoV-2 pandemic in Germany was hampered by the lack of an adequate health research infrastructure. The Network University Medicine (NUM) was founded at the beginning of the pandemic with the aim of preparing Germany for future pandemics. The aim of the project "PREparedness and PAndemic REsponse in Deutschland (PREPARED)" is to develop a holistic concept for a cooperative, adaptable and sustainable health research infrastructure within the NUM and thus contribute to pandemic preparedness and rapid response. The proposed concept for a health research infrastructure includes four core and three supporting functionalities in four different fields of action. The functionalities aim to ensure efficient functioning within the health research system and a rapid translation to other systems in future health crises. The four fields of action are (a) monitoring and surveillance, (b) synthesis and transfer, (c) coordination and organization, and (d) capacities and resources. The seven functionalities include 1) a monitoring and surveillance unit, 2) a pathogen competence platform, 3) evidence synthesis and trustworthy recommendations, 4) a regional networking and implementation unit, 5) a strategic communication unit, 6) human resources management, and 7) a rapid reaction and the response (R3)-cockpit. A governance will be established as a control and regulatory system for all structures and processes, testing agile management in non-pandemic times to improve responsiveness and flexibility and to investigate the suitability of the methods for scientific pandemic preparedness. The establishment of the PREPARED health research infrastructure must take place before the next pandemic, as training and regular stress tests are its fundamental prerequisites.