Perspektiven für Anästhesisten in der Krankenhaushygiene

Zusammenfassung

Hintergrund

Die Hygieneverordnungen der Länder schreiben vor, dass sich Krankenhäuser von einem Krankenhaushygieniker beraten lassen müssen. Der empfohlene zeitliche Umfang hat in den letzten Jahren zugenommen. Um den Bedarf zu decken, hat die Bundesärztekammer 2011 die strukturierte curriculare Fortbildung Krankenhaushygiene entwickelt. Ziel der vorliegenden Untersuchung ist es, den aktuellen Stand dieser Fortbildung darzustellen.

Methodik

Insgesamt 91 curriculare Krankenhaushygieniker wurden per E‑Mail eingeladen, an einer Umfrage über das Online-Abfragetool SurveyMonkey (San Mateo, USA) teilzunehmen. Per Internetrecherche sowie Anfragen per E‑Mail und Telefon wurden die Rahmenbedingungen der Landesärztekammern (LÄK) und die Anzahl der Abschlüsse ermittelt.

Ergebnisse

Circa 250 Ärzte hatten die Fortbildung bis Ende 2017 abgeschlossen. Es waren häufig Fachärzte für Anästhesie, die sich für die Hygiene entschieden (45 %). Die Mehrheit (78 %) hat eine zusätzliche Weiterbildung in Antibiotic Stewardship (ABS) und/oder Infektiologie. Die Vorgaben zu Weiterbildungszeit, Prüfung und Abschluss unterscheiden sich zwischen den einzelnen LÄK. Die Supervision wird hinsichtlich Umfang und Inhalt unterschiedlich umgesetzt.

Diskussion

Durch die curriculare Fortbildung konnte die Anzahl an Krankenhaushygienikern deutlich erhöht werden. Um eine vergleichbare Qualität zu garantieren, müssen die Rahmenbedingungen der Ausbildung bundesweit vereinheitlicht und die Supervision genauer vorgegeben werden. Stärken der Krankenhaushygieniker mit curricularer Fortbildung sind die klinische Erfahrung, Führungsroutine und die Expertise in Infektiologie/ABS. Durch die verbindliche Integration von ABS und Infektiologie in das Curriculum würde die Fortbildung weiter an Profil gewinnen.

Abstract

Background

It is mandatory for hospitals in Germany to employ infection control physicians and have an external consultation. The recommended coverage has substantially increased in the last years. Typically, infection control physicians are specialists for hygiene and environmental medicine and/or for microbiology. As there is already a shortage of these specialists, a curricular educational program in infection control was developed by the German Medical Association in 2011. This program addresses specialists of different clinical disciplines. It covers a period of 24 months and includes 200 h of courses, divided into 6 modules. In addition, 7 weeks of internships must be absolved in hospital hygiene, in a microbiological laboratory and in the public health service. During the program, the trainee must be accompanied by a qualified supervisor, who is a specialist in hygiene. The aim of this article is to describe the current status of this program.

Methods

A total of 91 infection control physicians, organized in different networks, were invited by email to take part in a survey with the online tool Survey Monkey (San Mateo, USA). The questions in the survey aimed at the characteristics of the participants as well as the conditions of the program. Further information about the various general regulations and conditions of the course was gathered through internet research, and from telephone and email contact with the State Medical Associations.

Results

Approximately 250 physicians completed the program between 2011 and 2017. The graduates were mostly anesthesiologists (45%) and 81% had a leading position (consultant or higher) before beginning the program. Most of them also had further education in antibiotic stewardship and/or infectious diseases. The requirements regarding training hours, examination and certification varied between the State Medical Associations. The supervision, a mandatory part of the program, is also implemented differently from state to state. Of the participants 49% felt well-qualified for the challenges ahead after finishing this program.

Discussion

The program was able to increase the number of infection control physicians in a relatively short period of time; however, to guarantee a comparable quality of education it is necessary to standardize the requirements on a national level. The supervision also needs to be further specified. A new program is currently being developed by the German Medical Association, which will hopefully lead to an improvement of the educational program. Special strengths of the new infection control physicians are the broad clinical experience as well as the additional qualifications in antibiotic stewardship and/or infectious diseases. The weaknesses are the lack of practical experience and knowledge of technical hygiene. A mandatory inclusion of antibiotic stewardship and infectious diseases in the program would increase its impact. Anesthesiologists are well-suited for training as infection control physicians. For them, a new, exciting field of activity has opened up with the chance to be the head of their own department.