[Surveillance of hygiene by local public health authorities - recommendations (not only) for the public health service in Rhineland-Palatinate]

Protection against communicable diseases and the prevention of their transmission require continuous surveillance by the public health service. There is also a need for targeting certain -hygiene standards and expert advice concerning their application, especially in institutions where medical interventions provide an increased risk for patients, staff and the public (e. g., intensive care units in hospitals or ambulatory dialysis centres). While the kind of institutions at risk is sufficiently governed in the German law (either at national or state level), the frequency of side visits as well the content and depth of surveillance activities lack adequate regulation. As the implementation of the national Protection against Infections Act in 2001 has enlarged the work load of local public health authorities without adequate staff compensation a risk-based strategy is required for efficient work scheduling. In Rhineland-Palatinate a task force of experts mandated by the ministry of health has developed recommendations on how often and with which expertise side visits should be performed. Based on published evidence and expert knowledge, an assessment of the institutional risk has been conducted leading to concrete patterns. High risk areas should be monitored every year, whereas three-year and five-year intervals are sufficient for institutions at middle or low risk respectively. This scheme represents a standard which should be applied by all public health departments in the state (and maybe also in other states). On the one hand the execution of this standard is expected to ascertain more transparency, predictability and comprehensibility for all involved parties. On the other hand the time and qualification pattern complements the general guidelines of the national steering committee for hospital hygiene and infectious disease protection (KRINKO). It is hoped that the combination of both elements will support the professional -dialogue between public health authorities and representatives of the affected institutions -leading to a common understanding of what communicable -disease protection is all about.