gms | German Medical Science

When Orpheus glanced back at his wife Eurydice, his action had sad consequences. This is how this episode is reported in Greek mythology. When the present author looks back on the decades of work undertaken by Euridiki (European Interdisciplinary Committee for Infection Prophylaxis), there can be no question of sadness because impressive results have been obtained!

The advent of intensive care medicine dates back some 40 years. The leading protagonists in this new medical discipline were primarily the anesthetists. A survey conducted in 1994 revealed that of 993 German hospitals, 915 had an intensive care unit, 89% of which were managed by anesthetist(s). The rising number of immunoincompetent patients who had to undergo intensive care treatment induced the anesthetists in particular to focus on the serious problem of nosocomial infections. At that time not only did the majority of intensive care physicians have a lack of knowledge of the fundamentals of infectiology, but also of appropriate behavioral mechanisms in this setting. There were no recommendations available for infection prevention, or if there were they contradicted, in some cases to a considerable and confusing extent, existing guidelines. The clinicians who embraced these materials with the best of intentions soon realized that often the requirements formulated by the infection control experts were drafted merely at the desk, i.e. while they were theoretically correct and consistent they could not be successfully incorporated into everyday clinical practice. Hence demotivated, they often viewed the requirements as being excessively stringent. Besides, they looked to the USA, where the prevailing custom was to wash one’s hands instead of disinfecting them, where transfer areas (sluices) before the intensive care unit were rejected, where the latter were entered with normal outdoor shoes, where surface disinfection was viewed as unnecessary, with preference given to prescribing antibiotics in the event of infection.

EURIDIKI, founded in 1979 by H.-J. Molitor in Vienna, was one of the first serious and continuous initiatives aimed at bringing together experts from the field of hospital hygiene and intensive care medicine. The declared goal of this interdisciplinary committee was to formulate implementable behavioral rules for correct hygiene practices in intensive care units, so as to dispel uncertainty and give doctors and nurses a sense of confidence when discharging their everyday duties.

Activities commenced with unprecedented meticulous observation and subsequent evaluation of behavioral practices in intensive care units, of both doctors and nurses. The findings and recommendations, based on data collected in intensive care units in Belgium, Germany (West/East), and Austria, were first published in book form (“Infection Control in Intensive Care Units” – Hygiene an Intensivstationen). This investigation was repeated between 1994-1997 so as to note any progress made. Apart from these in-depth investigations, the group focused again and again on topical issues, e.g. infection statistics, needlestick injuries (1990) or compiled a guide to hygienic hand disinfection (1996). This was aimed at bringing theory and practice into line with each other.

The author, in his capacity of anesthetist and intensive care physician, had the good luck of being able to take part in the activities of the committee from the outset. Time and again it was impressed upon him how important it is for a clinician to have, apart from expertise in diagnosis and treatment, a thorough knowledge of the fundamentals of microbiology, disinfection and sterilization, immunology and especially of antibiotic-based treatment regimens. On the other hand, the infection control experts or microbiologists often were not sufficiency conversant with medical and nursing necessities or working practices. Retrospectively, it must be pointed out that in long discussions, culminating at times in sharp but always constructive differences of opinion, we learned a lot from each other. Our mutual understanding of lines of argumentation and viewpoints was evinced against a background of having to create the preconditions for formulation of concepts, which could be assumed to make a real contribution to enhancing the standard of infection control for patients undergoing treatment. These working activities over the years were thorough, varied, and always of clinical relevance.

To assure effective prophylaxis against hospital infections, it is not only of clinical treatment principles that adequate knowledge is needed but also of the infection risks they pose. Doctors as well as assistant personnel must be conversant with disinfection and sterilization methods and indications. Likewise, experience is needed in diagnosis and differential diagnosis of infections, with associated immunological implications, microbiology, body secretions’ (specimen) collection and transportation, including interpretation of microbiological and infection/immunological results. Of paramount importance is precise knowledge of antimicrobial chemotherapy, of dosages tailored to the respective case, of potential development of resistance and of adverse side affects.

The results of the EURIDIKI investigations have revealed that physicians working in areas with high infection risks, such as in intensive care units, need to have a much better knowledge of the disciplines outlined above than appears to be case at present. But infection control physicians must also be in possession of this knowledge. External infection control experts who are consulted by hospitals should be informed not only about the priorities governing infection control rules, but must also know how to implement these. This means they must be familiar with the diagnostic and therapeutic principles and procedures underlying medical and nursing measures, bearing in mind the existing structural conditions and human resources availability. As such, these infection control experts would largely assume the duties of an infectiologist.

It can be assumed if the aforementioned conditions were to be assured, the ongoing, often emotionally charged controversies regarding the “correct” infection prophylaxis would belong to the unillustrious past.

EURIDIKI members have been: Herbert Benzer, Peter Brühl, Werner Dietzel, Ludwig Grün, Jürgen Kilian, Axel Kramer, Franz Lackner, Gerald Reybrouck, Manfred Rotter, Gernot Pauser, Volker Hingst, Günther Wewalka, Werner Lingnau, Ulrich Hartenauer.

Figure 1 [Fig. 1]

Emeritus Medical Director of the University Teaching Hospital Municipal Clinics in Leverkusen.

Werner Georg Dietzel completed his study of medicine in 1963 and received his licensure in 1964. For his special training he moved to the University of Heidelberg, later on to the USA and finally he became specialist for anaesthetics and intensive care medicine in 1969. A year later he got his doctors degree and at the same time became assistant medical director at the University of Heidelberg.

In 1971 he is called to the Municipal Hospital of Leverkusen to become Directing Doctor for Anaesthetics and Operative Intensive Care Medicine. In 1974 he became supernumery professor for the Federal State of Baden-Wuerttemberg. He teaches at the Medicinal Faculty of the University of Cologne since 1978 and finally received a call as professor by the Federal State of North Rhine-Westphalia in 1985. From 1998 until 2000 Professor Dietzel was the Medicinal Director of the clinical centre of Leverkusen.

Professor Dietzel has been (aside from his membership in many other groups and associations) a founding member of the scientific task force EURIDIKI (European Interdisciplinary Committee for Infections Prophylaxis).

In the year 2000 he took on the ermeritus status.