Learning from the Netherlands: Ethics and the hygienic standards in European healthcare

Recent media coverage has given much attention to public awareness of problematic hygienic standards in European hospitals.

The media in the UK and in Belgium report that healthcare providers and citizens are concerned about cases of the appearance of an enzyme called NDM-1, an enzyme that makes the bacteria which produce it resistant to a powerful group of antibiotics (carbapenems).
It is currently thought that the recent cases of NDM-1 infection can be traced back to treatment in India and Pakistan. So far, only patients who had treatment in these countries have been reported to have fallen ill. However, it is feared by some that the resistant bacteria will spread further through Europe.

In Germany, public awareness of hygienic problems in healthcare has recently been raised as a result of the deaths of three babies at the University Hospital of Mainz (2 & 3). According to media reports, the babies had been fed using contaminated feeding trips.
The radio station Deutsche Welle (DW) reports that in the meantime, the hospital workers have been cleared of any blame, since the contamination most likely occurred at a time between the bottles being filled and delivered to the hospital. 
Earlier this summer, another German hospital scandal had raised related concerns. It is reported that several surgical instruments used in Munich hospitals had not been cleaned properly, something that led to infections among patients.

Different as these cases and their causes may be, it is remarkable that, as yet, only 5 of 16 federal states ("Bundesländer") have hospital hygiene ordinances, and not all German hospitals employ hygienists. Due to the recent events in Mainz and Munich, there is a public debate about whether the law should require that all German hospitals employ an expert on hygiene.

Some comparative research has been done into different European approaches to the problems of hospital hygiene. In the Netherlands(2 & 3), problems with multi-resistant germs such as MRSA in hospitals seem to have been tackled with considerable success.

Among other measures used in the Netherlands, all patients with MRSA are isolated so that they cannot infect others.

Reading the news reports, I think that Germany has much to learn from the Netherlands. Some cooperation and exchange of knowledge already takes place in some border regions of Germany and the Netherlands, which is certainly of great benefit to the German partners.

As far as the hygienic situation in German healthcare is concerned, my view is that the first ethical challenge is to put the recent scandals in perspective in light of problems surrounding rationing: Hospitals work under great pressure to save expenses at all means. In a video on its website, the Bavarian Radio station BR claims that the hospital scandal in Munich was related to the efforts to save money in the wrong place, i.e. when it came to the sterilization of surgical instruments.
According to the radio station Deutsche Welle , who has interviewed some experts, there are other factors relevant to hospital hygiene (2), such as whether doctors and staff members wash and disinfect their hands regularly and whether the amount of antibiotics distributed can be reduced (because they lead to many more resistances).

In my opinion, a decision has to be made by the German government to invest into sustainable hygiene plans now. What is needed is a healthcare system that includes more instruction for medical students in hospital hygiene, allows hospital staff to work under less time-pressure and financial restrictions and handles the use of antibiotics with more care.
An investment in this will certainly pay off once the number of hospital related infections declines.

The second ethically relevant issue is to assign clear responsibilities to those in charge – which is difficult in the complex world of healthcare. Whereas it seems to me that up to now the responsibilities for most hospital related infections in Germany have not been clearly defined, the time has come to point the finger at the German government which has hesitated too long to make nationwide hygienic standards binding and to make those who don’t meet these standards liable for their actions. 

Both ethical considerations probably hold for other European countries that struggle with similar problems. In the end, in a Europe with open borders, we have to join forces to raise hygienic standards in European healthcare as a whole. Bacteria, after all, are known not stop at national borders.
As a country that is performing especially well with respect to healthcare hygiene, the Netherlands will certainly play a prominent role in this process.