Krankenhaushygiene in Zeiten von DRG, IfSG, SGB V und Verwaltungsreform - Fakten und Visionen aus Bayern

Since 1 January 2001, German hospitals and establishments engaged in outpatient surgery are obliged to continually record and evaluate nosocomial infections and the emergence of nosocomial pathogens showing special resistance and multi-resistance profiles. A survey conducted among 164 hospitals revealed that 79 % of establishments already carried out separate surveillance and evaluation of postoperative wound infections, while 77 % also recorded nosocomial infections and 91 % recorded pathogens with special resistance and multi-resistance profiles. However, only the larger hospitals had their own in-house infection control physician, while the smaller establishments generally consulted external infection control physicians. When asked how long such experts made their services available to the hospitals, no clear answer was given. Furthermore, only two-thirds of hospitals had their own infection control nurses (most of whom worked part time). These findings have induced the State Office for Health and Food Safety (LGL) in Bavaria to expand its advisory and information services and to formulate standards in consultation with partners at state level. The public health offices are legally obliged to supervise infection control policies in hospitals and medical establishments. These supervisory activities have not always been conducted in a uniform manner, thus engendering anxiety among the institutions to be supervised when it comes to discharging their prescribed duties. A concept devised to improve and standardize the monitoring of hospital hygiene is to be used to standardize supervision of infection control practices (by the statutory authorities). With the incorporation of the, hitherto, State Office for Occupational Safety, Occupational Medicine and Safety Engineering into the LGL, the specialist centers for public health and the Trade Supervisory Office will be united under one umbrella. The idea is to avail of the resulting improved cooperation possibilities, so as to avoid duplication of effort as regards the overlapping areas of medical and trade supervision and limit contradictory commentaries and avoid a situation whereby several public health officials have to pay visits to the various establishments. This will also reinforce partnerships between medical establishments and the public health authorities at local level. Some thirty years ago, while the present author could possibly dream of such an outcome when he took his first steps into the, at times arduous, terrain of hospital hygiene, he probably would not have dared to express it.Seit dem 1. Januar 2001 müssen Krankenhäuser und Einrichtungen zum ambulanten Operieren nosokomiale Infektionen und das Auftreten von Krankheitserregern mit speziellen Resistenzen und Multiresistenzen fortlaufend aufzeichnen und bewerten. Im Rahmen einer Befragung von 164 Krankenhäusern stellte sich heraus, dass bereits 79% der Häuser postoperative Wundoperationen gesondert erfassen, 77% auch nosokomiale Infektionen. 91% erfassen Erreger mit speziellen Resistenzen und Multiresistenzen. Dafür verfügen nur die größeren Häuser über einen eigenen Hygieniker, während die kleineren vorzugsweise mit externen zusammenarbeiten. Die Frage nach der Zeit, in der diese Externen den Krankenhäusern zur Verfügung stehen, konnte nicht eindeutig geklärt werden. Nur Zweidrittel der Häuser verfügen zudem über Hygienefachkräfte (hauptsächlich teilzeitbeschäftigt). Die Ergebnisse bestärkten das Landesgesundheitsamt in Bayern, sein Beratungs- und Informationsangebot zu verstärken und gemeinsam mit den Partnern auf Landesebene Standards zu entwickeln. Die Gesundheitsämter sind gesetzlich verpflichtet zur infektionshygienischen Überwachung der Krankenhäuser und medizinischen Einrichtungen. Diese Überwachung wurde nicht immer einheitlich durchgeführt, was bei den zu Überwachenden Unsicherheit hinsichtlich der zu erfüllenden Vorgaben schafft. Ein Konzept zur Verbesserung und Standardisierung der krankenhaushygienischen Überwachung soll dazu dienen, eine Vereinheitlichung der infektionshygienischen Überwachung zu erzielen. Mit der Integration des bisherigen Landesamtes für Arbeitsschutz, Arbeitsmedizin und Sicherheitstechnik in das Landesgesundheitsamt werden die fachlichen Leitstellen und die Gewerbeaufsicht zudem unter einem Dach vereint. Es gilt, die sich hieraus ergebenden verbesserten Kooperationsmöglichkeiten zu nutzen, um auf den sich überlappenden Feldern der Medizinal- und der Gewerbeaufsicht unnötige Doppelarbeit, sich widersprechende Stellungnahmen und Multipräsenz von Behördenmitarbeitern vor Ort einzugrenzen. Dies wird auch das partnerschaftliche Miteinander von medizinischen Einrichtungen und öffentlicher Verwaltung auf lokaler Ebene stärken. Eine derartige Vision vor etwa 30 Jahren zu entwickeln, hätte sich der Autor bei seinen damaligen ersten Schritten auf dem bisweilen glatten Parkett der Krankenhaushygiene vielleicht zu träumen, aber wahrscheinlich nicht zu formulieren gewagt

Timing of ontogenetic changes of two cranial regions in Sotalia guianensis (Delphinidae)

Despite the fact that heterochronic processes seem to be an important process determining morphological evolution of the delphinid skull, previous workers have not found allometric scaling as relevant factor in the differentiation within the genus Sotalia. Here we analyzed the skull ontogeny of the estuarine dolphin S. guianensis and investigate differential growth and shape changes of two cranial regions the neurocranium and the face in order to evaluate the relevance of cranial compartmentalization on the ontogeny of this structure. Our results show that, even though both cranial regions stop growing at adulthood, the face has higher initial growth rates than the neurocranium. The rate of shape changes is also different for both regions, with the face showing a initially higher, but rapidly decreasing rate of change, while the neurocranium shows a slow decreasing rate, leading to persistent and localized shape changes throughout adult life, a pattern that could be related to epigenetic regional factors. The pattern of ontogenetic shape change described here is similar to those described for other groups of Delphinidae and also match intra and interspecific variation found within the family, suggesting that mosaic heterochrony could be an important factor in the morphological evolution of this group. (C) 2012 Deutsche Gesellschaft fur Saugetierkunde. Published by Elsevier GmbH. All rights reserved.CAPESCAPESFAPESPFAPESP [07/52144-5, 01/07053-8

Clinical and mutation analysis of 51 probands with anophthalmia and/or severe microphthalmia from a single center

Clinical evaluation and mutation analysis was performed in 51 consecutive probands with severe eye malformations – anophthalmia and/or severe microphthalmia – seen in a single specialist ophthalmology center. The mutation analysis consisted of bidirectional sequencing of the coding regions of SOX2, OTX2, PAX6 (paired domain), STRA6, BMP4, SMOC1, FOXE3, and RAX, and genome-wide array-based copy number assessment. Fifteen (29.4%) of the 51 probands had likely causative mutations affecting SOX2 (9/51), OTX2 (5/51), and STRA6 (1/51). Of the cases with bilateral anophthalmia, 9/12 (75%) were found to be mutation positive. Three of these mutations were large genomic deletions encompassing SOX2 (one case) or OTX2 (two cases). Familial inheritance of three intragenic, plausibly pathogenic, and heterozygous mutations was observed. An unaffected carrier parent of an affected child with an identified OTX2 mutation confirmed the previously reported nonpenetrance for this disorder. Two families with SOX2 mutations demonstrated a parent and child both with significant but highly variable eye malformations. Heterozygous loss-of-function mutations in SOX2 and OTX2 are the most common genetic pathology associated with severe eye malformations and bi-allelic loss-of-function in STRA6 is confirmed as an emerging cause of nonsyndromal eye malformations